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目的对需要抗心绞痛治疗并且左心室功能代偿症状稳定的心绞痛患者建立预测全因死亡、心肌梗死和导致致残性卒中的复合危险评分。设计大型多中心临床试验数据的多变量Cox回归分析。背景西欧、以色列、加拿大、澳大利亚和新西兰的心脏专科门诊患者。入选者7311例具有全部需要资料的患者被入选。主要结局的测量指标平均随访4.9年时间内所有原因的死亡、心肌梗死或者致残性卒中。结果1063例患者发生任何原因死亡或者持久性心肌梗死或者致残性卒中。这些复合终点的5年危险性在危险性最低的十分位患者为4%,而在危险性最高的十分位患者为35%。危险评分结合16项临床常规变量的降序排序是:年龄、左心室射血分数、吸烟、白细胞计数、糖尿病、随机血糖浓度、肌酐浓度、既往卒中病史、1周至少1次心绞痛发作、冠状动脉造影发现(如果能够获得)、降脂治疗、QT间期、收缩期血压≥150mmHg、抗心绞痛药物数量、陈旧性心肌梗死以及性别。把这个模型分别应用于任何原因所致的死亡、心肌梗死和卒中进行预测评估,所得的结果相似。危险评分似乎不能预测事件性质(39%的死亡、46%心肌梗死以及15%致残性卒中)或者冠状动脉造影或血管重建率(占29%的患者)。结论该危险评分对客观地决定稳定性心绞痛患者进一步治疗措施以减少重要预后事件发生是有帮助的。该危险评分同样可以用于将来的计划性试验。
Objective To establish composite risk scores for all-cause death, myocardial infarction, and stroke-induced stroke in angina patients who require anti-anginal therapy and stable left ventricular dysfunction symptoms. Multivariate Cox Regression Analysis for Designing Large, Multicentre Clinical Trial Data. Background Heart specialist outpatient in Western Europe, Israel, Canada, Australia and New Zealand. 7311 patients with all required information were enrolled. MEASUREMENTS OF MAIN OUTCOME MEASURES Mean follow-up All-cause death, myocardial infarction, or disabling stroke within 4.9 years. Results 1063 patients died of any cause or persistent myocardial infarction or disabling stroke. The 5-year risk for these composite endpoints was 4% among those with the lowest risk and 35% among those with the highest risk. Risk scores combined with the descending order of 16 clinical routine variables were: age, left ventricular ejection fraction, smoking, white blood cell count, diabetes mellitus, random glucose concentration, creatinine concentration, history of previous strokes, angina at least 1 episode per week, coronary angiography Found (if available), lipid-lowering therapy, QT interval, systolic blood pressure> 150 mmHg, number of anti-anginal drugs, old myocardial infarction, and gender. The model was applied to predict the death, myocardial infarction and stroke caused by any reason, the results obtained are similar. The risk score did not seem to predict the nature of the event (39% death, 46% myocardial infarction and 15% disabling stroke) or coronary angiography or revascularization (29%). Conclusions The risk score is helpful for objectively determining further treatment for patients with stable angina to reduce the incidence of major prognostic events. The risk score can also be used for future planned tests.