临床衰弱指数对急性心肌梗死患者在院心脏康复后远期预后的预测价值  

Predictive value of Clinical Frailty Scale in long term prognosis of patients with acute myocardial infarction after in-hospital cardiac rehabilitation

作　　者：刘雨婷 俞莞琦 洪雯 康桑 李歆旎 旦增曲央 肖活源 潘静薇[1] LIU Yuting;YU Wanqi;HONG Wen;KANG Sang;LI Xinni;DANZENG Quyang;XIAO Huoyuan;PAN Jingwei(Department of Cardiology,Shanghai Sixth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China;Department of Rehabilitation Medicine,Shanghai Sixth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院心内科,上海200233 [2]上海交通大学医学院附属第六人民医院康复医学科,上海200233

出　　处：《上海交通大学学报（医学版）》2024年第5期599-605,共7页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市2021年度“科技创新行动计划”医学创新研究专项(21Y11909400)。

摘　　要：目的·探讨临床衰弱指数(Clinical Frailty Scale,CFS)对急性心肌梗死(acute myocardial infarction,AMI)患者在院心脏康复(cardiac rehabilitation,CR)后远期预后的预测价值。方法·序贯纳入2020年5月至2022年5月在上海交通大学医学院附属第六人民医院心脏中心接受诊治的501例AMI患者。采集患者基本临床信息,制定分级在院CR方案。根据患者出院前的CFS等级将患者分为3组,即正常(norm)组、脆弱(vulnerable)组和衰弱(frail)组,比较3组患者1年主要心血管事件率,包括全因死亡率及心力衰竭(心衰)再住院率。采用Logistic回归分析研究影响主要心血管事件率的危险因素,通过受试者操作特征(receiver operator characteristic,ROC)曲线分析各危险因素对主要心血管事件率的预测价值,建立最佳风险预测模型。结果·AMI患者在院CR后衰弱程度与高龄、B型利钠肽前体峰值(peak pro-B-type natriuretic peptide,peak proBNP)呈正比,与性别差异呈反比(P<0.05)。随患者衰弱程度增加,两种事件率均增高;其中全因死亡率(分别为2.6%、5.6%、15.2%)的组间差异有统计学意义(P=0.002),心衰再住院率(分别为19.6%、22.2%、24.2%)的组间差异无统计学意义。两两比较,frail组全因死亡率显著高于norm组(P=0.004),但vulnerable组与norm组的差异无统计学意义。CFS分级能够敏感预测AMI患者1年后的全因死亡风险(β=1.89,OR=6.61,P=0.001),且叠加CFS分级的风险模型预测效应最佳(AUC=0.845,P=0.000)。结论·接受在院CR的AMI患者出院前进行CFS分级,有助于识别1年内全因死亡风险较高的人群。Objective·To investigate the predictive value of the Clinical Frailty Scale(CFS)in the long term outcomes in acute myocardial infarction(AMI)patients who completed in-hospital cardiac rehabilitation(CR).Methods·A total of 501 AMI patients treated in the Cardiology Center of Shanghai Sixth People's Hospital,Shanghai Jiao Tong University of Medicine from May 2020 to May 2022 were prospectively enrolled,with their baseline clinical data collected.The patients completed graded in-hospital CR and were assessed by CFS based on their completion of CR before discharge.Patients were then categorized into three groups(norm group,vulnerable group and frail group)according to their CFS level.The difference in 1-year major cardiovascular event(all-cause death and re-hospitalization for heart failure)rates among the three groups was investigated.Logistic regression analysis was performed to explore the effective risk factors relevant to the outcomes,and receiver operator characteristic(ROC)curves were generated to analyze the prognostic value.Finally,an optimal prediction model was developed.Results·The CFS level in AMI patients who completed CR was positively correlated with age and peak pro-B-type natriuretic peptide(peak proBNP),and inversely correlated with gender difference(P<0.05).Accompanied with the elevated CFS level,the incidence of both outcomes increased,and there were significant differences in all-cause death(2.6%,5.6%and 15.2%,P=0.002),and while no significant differences in re-hospitalization for heart failure among the three groups(19.6%,22.2%and 24.2%).All-cause death of the frail group was significantly higher than that of the norm group(P=0.004),while there was no significant difference between the vulnerable group and the norm group.CFS could sensitively predict the 1-year all-cause death in AMI patients(β=1.89,OR=6.61,P=0.001),and the risk model combined with CFS had the best predictive effect(AUC=0.845,P=0.000).Conclusion·Assessment by CFS in AMI patients who completed in-hospital CR contributes to

关 键 词：急性心肌梗死 在院心脏康复 临床衰弱指数 主要心血管事件率 全因死亡 

分 类 号：R541.4[医药卫生—心血管疾病]