[Comparison on the predictive value of different scoring systems for risk of short-term death in patients with acute myocardial infarction complicating cardiogenic shock].

• DOI: 10.3760/cma.j.issn.0253-3758.2018.07.005
• Publication Date: 2018-07-24
• Authors: Chunyan Guo; Xin-La Luo; Xingjuan Gao; JIANG-PING WANG; Rongcan Liu; J Li; J Zhang; Wenlong Yang; Feng Hu; Yuping Wu; Yijiong Yang; S B Qiao
• Keywords: TIMI; Coronary care unit; Killip class

Objective: To compare predictive value of the current 7 scoring systems and CADILLAC-plus system for risk short-term deathin patients with acute myocardial infarction complicating cardiogenic shock. Methods: A total 126 shock hospitalized in Fuwai hospital from June 2014 to January 2018 were enrolled this study, clinical data retrospectively analyzed. The divided into survival group(49 cases) death group(77 according or not at 28 days after diagnosis shock.The scores APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,PAMI, TIMI-STEMI,TIMI-NSTEMI,and CADILLAC calculated within 24 hours coronary care unit (CCU),and CADILLAC-plus, which is an improved score derived CADILLAC, was also calculated. different day smortality compared patient cohort. Results: Scores APACHEⅡ,APACHEⅢ,SAPSⅡ,PAMI,TIMI-STEMI, TIMI-NSTEMI,CADILLAC,and all significantly higher group than group: (28.9±10.2 vs. 21.8±8.3,94.0 (57.0,114.0) 57.0 (45.4,81.5) ,62.0 (46.0,81.0) 47.0 (41.5,60.5) ,7.0 (6.0,9.0) 6.0 (6.0,7.5) ,10.0 (9.0,11.0) 9.0 (8.0,10.0) ,4.0 (3.0,5.0) 3.0 (3.0,4.0) (7.0,12.0) 7.0 (5.0,9.0) ,and 10.0 (8.0,14.0) (5.0,10.0) , respectively, P<0.01).The area under curve(AUC) receiver operating characteristic(ROC) curve predicting 0.820,0.797,0.785,0.667,0.657,0.711,and 0.821,respectively cut-off 27.5,79.5,66.0,8.5,10.5,3.5,and 8.5, respectively sensitivity 0.766,0.844,0.649,0.494,0.494,0.740,and 0.753, specificity 0.816,0.755,0.837,0.204,0.796,0.571,and 0.755,respectively.The AUC ROC 0.885,cut-off 9.5, 0.896,and 0.735. efficacy superior other systems. Conclusion: are suitable theshort-term shock, cohort.目的： 比较目前常用的7种评分系统及改良的CADILLAC-plus评分对急性心肌梗死合并心原性休克患者近期死亡的预测价值。 方法： 纳入2014年6月至2018年1月在阜外医院住院的急性心肌梗死合并心原性休克患者126例，对其临床资料进行回顾性分析。根据明确诊断心原性休克后28 d患者是否存活，将患者分为存活组（49例）及死亡组（77例）。分别计算入住冠心病重症监护室（CCU）后24 h内的APACHE Ⅱ、APACHE Ⅲ、SAPSⅡ、PAMI、TIMI-STEMI、TIMI-NSTEMI和CADILLAC评分，并通过对CADILLAC评分进行改良获得CADILLAC-plus评分，比较不同评分系统对急性心肌梗死合并心原性休克患者发病后28 d死亡的预测价值。 结果： 死亡组的APACHE Ⅲ、SAPS Ⅱ、PAMI、TIMI-STEMI、TIMI-NSTEMI、CADILLAC和CADILLAC-plus评分均高于存活组[分别为（28.9±10.2）分比（21.8±8.3）分、94.0（57.0,114.0）分比57.0（45.4,81.5）分、62.0（46.0,81.0）分比47.0（41.5,60.5）分、7.0（6.0,9.0）分比6.0（6.0,7.5）分、10.0（9.0,11.0）分比9.0（8.0,10.0）分、4.0（3.0,5.0）分比3.0（3.0,4.0）分、10.0（7.0,12.0）分比7.0（5.0,9.0）分和10.0（8.0,14.0）分比7.0（5.0,10.0）分，P均<0.01]。APACHE Ⅱ、PAMI、TIMI-STEMI、TIMI-NSTEMI和CADILLAC评分预测死亡的ROC曲线下面积分别为0.820、0.797、0.785、0.667、0.657、0.711和0.821，截断点分别为27.5、79.5、66.0、8.5、10.5、3.5和8.5分，敏感度分别为0.766、0.844、0.649、0.494、0.494、0.740和0.753，特异度分别为0.816、0.755、0.837、0.204、0.796、0.571和0.755；CADILLAC-plus评分的ROC曲线下面积为0.885，截断点为9.5分，敏感度为0.896，特异度为0.735，优于其他评分系统。 结论： 目前常用的7种评分系统均可较好地预测急性心肌梗死合并心原性休克患者的近期死亡，而改良的CADILLAC-plus评分的预测能力更佳。.