心肌梗死溶栓试验评分对急性ST段抬高型心肌梗死患者预后风险的预测价值

摘要

目的 探讨心肌梗死溶栓试验(TIMI)评分对评估急性ST段抬高型心肌梗死(STEMI)患者预后和死亡风险的预测价值.方法 选择2014年2月至2016年1月在哈尔滨医科大学附属第二医院经冠状动脉造影确诊的急性STEMI患者72例为观察组,选择临床初步诊断为急性心肌梗死、但冠状动脉造影结果为阴性患者72例为对照组.2组患者均计算TIMI评分;记录观察组患者院内死亡情况;同时记录恶性室性心律失常发生情况.采用直线相关分析与Logistic回归分析方法,并绘制受试者工作特征(ROC)曲线,分析TIMI评分预测患者发生恶性室性心律失常与院内死亡的有效性.结果 观察组的TIMI评分明显高于对照组[(9.2±2.8)分比(5.2±1.9)分],差异有统计学意义(P＜0.05).观察组24 h内恶性室性心律失常发生率为8.3％ (6/72),院内死亡率为5.6％ (4/72).直线相关分析显示恶性室性心律失常、院内死亡与TIMI评分均呈现明显正相关(r=0.682、0.542,均P＜0.05).Logistic回归分析显示TIMI评分为导致恶性室性心律失常、院内死亡的独立危险因素(P＜0.05).ROC曲线分析显示TIMI评分预测患者发生恶性室性心律失常的曲线下面积(AUC)为0.57(95％置信区间:0.49～0.65),最佳诊断界值为9.49分;TIMI评分预测院内死亡的AUC为0.74(95％置信区间:0.66 ～0.81),最佳诊断界值为11.32分.结论 急性STEMI患者的TIMI评分与发生恶性室性心律失常、院内死亡具有良好相关性,TIMI评分对于临床上无创性评估急性STEMI患者预后风险具有较高的预测价值.%Objective To evaluate the value of thrombolysis in myocardial infarction (TIMI) score in assessing risks of prognosis and death in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods From February 2014 to January 2016,72 patients with acute STEMI diagnosed by coronary angiography in the 2nd Affiliated Hospital of Harbin Medical University were enrolled as observation group;72 patients who were presumptively diagnosed of acute myocardial infarction but had negative results in coronary angiography were enrolled as control group.TIMI score,occurrences of in-hospital death and malignant ventricular arrhythmia were recorded.The value of TIMI score in predicting death and malignant ventricular arrhythmia was analyzed by linear correlation,logistic regression and the receiver operating characteristic (ROC) curve.Results The TIMI score in observation group was significantly higher than that in control group [(9.2 ± 2.8) points vs (5.2 ± 1.9) points] (P ＜ 0.05).The 24 h incidence of malignant ventricular arrhythmia was 8.3％ (6/72) and the in-hospital mortality rate was 5.6％ (4/72) in observation group.Linear correlation analysis showed positive correlations between TIMI score with malignant ventricular arrhythmia and in-hospital death (r =0.682,0.542;P ＜ 0.05).Logistic regression analysis showed that TIMI score was an independent predictive factor of malignant ventricular arrhythmia and in-hospital death (P ＜ 0.05).ROC curve showed that the area under curve (AUC) of TIMI score in predicting malignant ventricular arrhythmia was 0.57 (95％ confidence interval =0.49-0.65) and the optimal cut-off value was 9.49 points;the AUC of TIMI score in predicting in-hospital death was 0.74 (95％ confidence interval =0.66-0.81) and the optimal cut-off value was 11.32 points.Conclusion TIMI score is positively correlated with occurrences of malignant ventricular arrhythmia and in-hospital death in patients with STEMI.