摘要
目的 探讨将来自于临床试验的介入治疗心肌梗死的危险评分（PAMI评分）应用于普通患有ST段抬高心肌梗死（STEMI）并接受直接PCI治疗的患者,评判其预测价值,以及冠状动脉病变程度与左心室射血分数对危险分层的意义.方法 应用PAMI评分对2002年3月至2004年5月因STEMI连续行直接PCI的患者206例进行危险分层,并电话随访6个月至1年的死亡率.计数资料应用秩和检验,计量资料用独立样本t检验,并应用非条件logistic回归分析各变量与发病后6个月的死亡率的关系.结果 随访到的183例患者中,PAMI评分在0～2分者有88例,3～5分者有54例,6～8分者有17例,≥9分有24例,死亡率分别为1.1%（1/88）,3.7%（2/54）,17.6%（3/17）,41.7%（10/24）,4组之间差异有统计学意义.Logistic回归分析显示冠状动脉血管病变支数是介入治疗后STEMI患者的危险因素（相对危险度10.186）,而左心室射血分数（LVEF）则为保护性因素（相对危险度0.849）.PAMI评分联合冠状动脉3支病变及入院48 h内的LVEF值可以增强死亡率的预测价值.结论 PAMI危险评分可以作为简便易行的方法评价直接PCI治疗后STEMI患者的死亡率,同时联合冠状动脉病变程度与左心室射血分数可以增加预测价值的精确性.
Objective To evaluate the prognosis capacity of the Primary Angioplasty in Myocardial Infarction （PAMI） risk score for 6 months mortality in the clinical patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention （PCI）, in addition to asses the incremental value of EF and multivessel disease for risk stratification. Methods Six clinical variables and their relative value of score derived from PAMI risk scoring system were used to determine individual＇ s risk score. The patients with STEMI were evaluated during the in-hospital period and followed-up for a mean of （ 10.34 ± 3.24） months for mortality. The p values were calculated using a Kruskal-Wallis H test for categorical variables when appropriate; otherwise Independent-samples test was used. Logistic regression examined the discriminant accuracy of the PAMI risk score to predict death and assessed the incremental value of the EF and multivessel disease. Results A 88.8% of patients （183 patients） finished the follow up of 6 months. The overall in-hospital mortality rate was 4.4%, 30-day mortality rate was 6% and 6 months mortality rate was 9.3%. Eighty-eight patients scored 0 - 2 points, 54 patients scored 3-5 points, 17 patients scored 6-8 points and 24 patients scored ≥9 points. The 6 months mortality were 1.1% ,3.7%, 17.6% and 41.7% respectively. Logistic regression analysis indicated that multivessel disease is a risk factor （ OR 10.189） and EF is a protected factor （ OR 0.849） for 6 months mortahty after PCI. Multivessel disease and EF provided incremental information over that provided by the PAMI risk score. The PAMI risk score can be applied in early stage after PCI for mortality risk assessment for patients with STEMI. EF and multivessel disease also convey important prognostic information and should be included in risk stratification after STEMI.
出处
《中国介入心脏病学杂志》
2006年第5期269-271,共3页
Chinese Journal of Interventional Cardiology
关键词
心肌梗死
血管成形术
经皮
经腔冠状动脉
危险因素
预后
Myocardial infarction
Angioplasty, transluminal, percutaneous coronary
Risk factors
Prognosis
