简单的ST升高急性心肌梗塞风险指数的有效性:随机试验的预后估计是否可以对老年患者进行概括?
Saif S Rathore1, Kevin P Weinfurt, Cary P Gross
1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn, USA.
Circulation
|February 20, 2003
概括
65岁以上的ST升高心肌梗塞患者的简单风险指数在社区环境中表现不佳. 该得分显示差异和校准差,突出了在现实世界患者队列中验证的必要性.
科学领域:
- 心脏病学 心脏病学
- 临床流行病学临床流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 对于ST升高心肌梗塞 (STEMI) 的风险分层得分需要在社区人口中进行验证.
- 最近提出的STEMI患者的简单风险指数,来自随机临床试验 (RCT) 数据,在社区队列中缺乏验证.
研究的目的:
- 为了评估一个简单的风险指数的表现,在一个大规模的,基于社区的老年患者队列 (>=65岁) 住院的STEMI.
- 为了评估该指数的歧视,校准,分数分布和30天死亡率估计,在这个人群中.
主要方法:
- 利用了49711名65岁或以上的患者的数据,这些患者患有STEMI.
- 评估了简单风险指数在风险组中的分布,比较观察到与公布的30天死亡率,并评估了歧视 (c-统计) 和校准 (适合性).
主要成果:
- 简单的风险指数表明30天生存期的差别差 (c=0.62) 和校准 (P<0.001).
- 评分分布是偏差的,有66.1%的患者在最高风险组.
- 观察到的30天死亡率高于指数的预测,特别是在高风险组和未接受再输液治疗的患者中.
结论:
- 简单的风险指数在适用于社区老年STEMI患者群体时表现有限.
- 这些发现强调了直接将在RCT中开发的预后模型应用于多样化,现实世界的患者群体的局限性.
- 在临床实践整合之前,在社区队列中验证预后得分至关重要.
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