血清白蛋白联合CatLet©冠状动脉评分预测急性心肌梗死患者预后  

The incorporation of serum albumin into the CatLet©score for predicting the prognosis of patients with acute myocardial infarction

作　　者：葛正阳 何怡 蒋廷波[1] 贺永明[1] GE Zheng-yang;HE Yi;JIANG Ting-bo;HE Yong-ming(Department of Cardiology,the First Affi liated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院心血管内科,江苏苏州215006

出　　处：《中国介入心脏病学杂志》2023年第3期187-194,共8页Chinese Journal of Interventional Cardiology

基　　金：江苏省卫生健康委科研项目(M2021019)。

摘　　要：目的探讨血清白蛋白联合冠状动脉树描述及病变评估(CatLet©)冠状动脉评分(简称复合模型)预测急性心肌梗死患者预后的价值。方法连续纳入2012年1月至2013年7月因急性心肌梗死在苏州大学附属第一医院行急诊经皮冠状动脉介入治疗(PCI)的患者。计算非闭塞状态下CatLet©冠状动脉评分,并收集入院时血清白蛋白水平等基线资料。主要终点为主要不良心脑血管事件(MACCE),次要终点为全因死亡和心原性死亡。通过受试者工作特征曲线下面积(AUC)、净再分类指数(NRI)与整体鉴别指数(IDI)比较CatLet©冠状动脉评分单纯模型(简称单纯模型)及复合模型的区分能力。通过Hosmer-Lemeshow拟合优度检验与一致性曲线图,检测模型的校正度。结果与单纯模型相比,复合模型MACCE、全因死亡以及心原性死亡AUC(95%CI)分别为[0.77(0.71~0.84)比0.71(0.64~0.78),P=0.010]、[0.80(0.73~0.86)比0.72(0.64~0.79),P=0.012]以及[0.82(0.75~0.88)比0.77(0.70~0.84),P=0.096]。进一步NRI和IDI分析表明,与单纯模型相比,复合模型中所有研究终点的NRI和IDI均大于0(均P<0.001),且复合模型较单纯模型有更好的校正度。结论血清白蛋白联合CatLet©冠状动脉评分复合模型可以更好地预测急性心肌梗死患者预后。Objective To evaluate whether serum albumin can improve the prediction ability of CatLet©angiographic scoring system for patients with acute myocardial infarction(AMI)with respect to clinical outcomes.Methods The CatLet©score was calculated in the non-occlusive status,serum albumin level and other baseline data at admission was collected for AMI patients who underwent primary PCI in the First Affi liated Hospital of Soochow University from January 2012 to July 2013.Primary endpoint was major adverse cardiac or cerebrovascular events(MACCE)at a median of 4.3-year follow-up,and secondary endpoints were all-cause death and cardiac death.The area under ROC curve(AUC),net reclassifi cation improvement(NRI)and integrated discrimination improvement(IDI)were used to compare the discrimination ability of the stand-alone CatLet©score and the CatLet©score combined with serum albumin.Models’calibration were assessed by Hosmer-Lemeshow test and calibration plots.Results The AUCs of the adjusted CatLet©score were larger than those of the stand-alone CatLet©score in MACCE[0.77(0.71–0.84)vs.0.71(0.64–0.78),P=0.010],in all-cause death[0.80(0.73–0.86)vs.0.72(0.64–0.79),P=0.012],and in cardiac death[0.82(0.75–0.88)vs.0.77(0.70–0.84),P=0.096].Compared with the stand-alone CatLet©score,the NRI and IDI of each end point of the adjusted CatLet©score were all greater than 0(all P<0.001).The calibration of the adjusted CatLet©score was better than the stand-alone CatLet©score with respect to clinical outcomes.Conclusions Serum albumin improved the prognostic ability of CatLet©angiographic scoring system for AMI patients.

关 键 词：冠状动脉评分系统 血清白蛋白 急性心肌梗死 预后 

分 类 号：R541[医药卫生—心血管疾病]