红细胞分布宽度与修正休克指数对ST段抬高型心肌梗死患者Mace预后的预测价值
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摘要
目的:探讨红细胞分布宽度(RDW)与修正休克指数(MSI)对预测急性ST段抬高型心肌梗死(STEMI)患者短期主要心脏不良事件(Mace)的价值。方法:选择2016年6月至2018年3月就诊于我院急诊科586例STEMI患者,收集一般资料及血常规、血压、心率,计算休克指数(SI)、MSI及录入RDW,患者分为Mace组与非Mace组。比较两组一般资料、心率、血压、红细胞分布宽度、休克指数及修正休克指数等指标。结果:Mace组(n=132)与非Mace组(n=454)患者的一般资料、心率、左心室射血分数(LVEF)等指标比较无明显差异。两组的收缩压、舒张压和Killip分级Ⅲ及Ⅳ级差异比较有统计学意义(P<0.05)。MACE组的SI、MSI及RDW明显高于非MACE组,差异比较有统计学意义(P<0.01)。患者院内Mace发生率为22.52%,包括6.48%(38例)全因死亡患者,SI、MSI及RDW的ROC曲线下面积分别为0.701、0.707和0.713,对预测STEMI患者的不良心脏事件具有统计学意义(P<0.001)。结论:SI、MSI及RDW均可能是预测急诊科STEMI患者短期预后简单、经济、有效的指标。
Objective: To explore the predictive value of modified shock index( MSI) and red biood cell distribution width( RDW) to in predicting short-term major cardiac adverse events( Mace) in patients with acute ST elevation myocardial infarction( STEMI). Methods: STEMI patients( n = 586) were chosen from the Department of Emergency in the emergency department of our hospital from June 2016 to March 2018 were selected,and general data,blood routine,blood pressure and heart rate were collected,shock index( SI),MSI and RDW were calculated,and were divided into Mace group and non-Mace group. General data,heart rate,blood pressure,RDW,SI and MSI were compared between the two groups. Results: STEMI patients were divided into Mace group( n = 132) and non-Mace group( n = 454). There were no statistically significant differences in the general data,heart rate,left ventricular ejection fraction( LVEF) and other indicators between the two groups( P >0.05). systolic pressure,diastolic pressure and The difference in systolic blood pressure,diastolic blood pressure,heart rate and Killip class Ⅲ and Ⅳ had statistical significance between two groups( P<0.05). SI,MSI and RDW in the MACE group were significantly higher than those in the non-mace group,and the difference was statistically significant( P < 0.01). The incidence of Mace in hospital was 22.52%,including 6.48%( n = 38) of all-cause death,and the ROC area under SI,MSI and RDW were 0.7010. 707 and 0. 713,respectively,which was of statistical significance in predicting the incidence of Mace in STEMI patients( P <0.001). Conclusion: SI,MSI and RDW may be simple,economical and effective indicators for predicting short-term prognosis of STEMI patients in emergency department.
Objective: To explore the predictive value of modified shock index( MSI) and red biood cell distribution width( RDW) to in predicting short-term major cardiac adverse events( Mace) in patients with acute ST elevation myocardial infarction( STEMI). Methods: STEMI patients( n = 586) were chosen from the Department of Emergency in the emergency department of our hospital from June 2016 to March 2018 were selected,and general data,blood routine,blood pressure and heart rate were collected,shock index( SI),MSI and RDW were calculated,and were divided into Mace group and non-Mace group. General data,heart rate,blood pressure,RDW,SI and MSI were compared between the two groups. Results: STEMI patients were divided into Mace group( n = 132) and non-Mace group( n = 454). There were no statistically significant differences in the general data,heart rate,left ventricular ejection fraction( LVEF) and other indicators between the two groups( P >0.05). systolic pressure,diastolic pressure and The difference in systolic blood pressure,diastolic blood pressure,heart rate and Killip class Ⅲ and Ⅳ had statistical significance between two groups( P<0.05). SI,MSI and RDW in the MACE group were significantly higher than those in the non-mace group,and the difference was statistically significant( P < 0.01). The incidence of Mace in hospital was 22.52%,including 6.48%( n = 38) of all-cause death,and the ROC area under SI,MSI and RDW were 0.7010. 707 and 0. 713,respectively,which was of statistical significance in predicting the incidence of Mace in STEMI patients( P <0.001). Conclusion: SI,MSI and RDW may be simple,economical and effective indicators for predicting short-term prognosis of STEMI patients in emergency department.
引文
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[8] Turcato G,Serafini V,Dilda A,et al. Red blood cell distribution width independently predicts medium-term mortality and major adverse cardiac events after an acute coronary syndrome[J]. Ann Transl Med,2016,4:254.
[9] Ghaffari S,Pourafkari L,Sepehrvand N,et al. Red cell distribution width is a predictor of ST resolution and clinical outcome following thrombolysis in acute ST elevation myocardial infarction[J]. Thromb Res,2016,140:1~6.
[10] Su C,Liao LZ,Song Y,et al. The role of red blood cell distribution width in mortality and cardiovascular risk among patients with coronary artery diseases:a systematic review and meta-analysis[J]. Thorac Dis,2014,6:1429~1440.
[2] Alcaino H,Pozo J,Pavez M,et al. Red cell distribution width as a risk marker in patients with cardiovascular diseases[J]. Rev Med Chil,2016,144:634~642.
[3] Azab B,Torbey E,Hatoum H,et al. Usefulness of red cell distribution width in predicting all-cause long-term mortality after non-ST-elevation myocardial infarction[J]. Cardiology,2011,119(2):72~80.
[4] Spyridopoulos I,Noman A,Ahmed JM,et al. Shock-index as a novel predictor of long-term outcome following primary percutaneous coronary intervention[J]. Eur Heart Acute Cardiovase Care,2014,4(3).
[5] Singh A,Ali S,Agarwal A,et al. Correlation of shock index and modified shock index with the outcome of adult trauma patients:a prospective study of 9860 patients[J]. N Am Med Sci,2014,6:450~452.
[6] Khaki S,Mortazavi SH,Bozorgi A,et al. Relationship between red blood cell distribution with and mortality of patients with acute myocardial infarction referring to tehran heart center[J]. Crit Pathw Cardiol,2015,14:112~115.
[7] Rosas-Cabral A,Viana-Rojas JA,Prieto-Macías J,et al.The association between red cell distribution width(RDW)and short-term mortality risk in patients with acute coronary syndrome(ACS)[J]. Article in Spanish Gac Med Mex,2016,152:70~77.
[8] Turcato G,Serafini V,Dilda A,et al. Red blood cell distribution width independently predicts medium-term mortality and major adverse cardiac events after an acute coronary syndrome[J]. Ann Transl Med,2016,4:254.
[9] Ghaffari S,Pourafkari L,Sepehrvand N,et al. Red cell distribution width is a predictor of ST resolution and clinical outcome following thrombolysis in acute ST elevation myocardial infarction[J]. Thromb Res,2016,140:1~6.
[10] Su C,Liao LZ,Song Y,et al. The role of red blood cell distribution width in mortality and cardiovascular risk among patients with coronary artery diseases:a systematic review and meta-analysis[J]. Thorac Dis,2014,6:1429~1440.