{"title":"70 岁以上心肌梗死患者体弱综合征后 12 个月内不良后果的预测","authors":"O. Aidumova, Y. Shchukin, A. O. Rubanenko","doi":"10.15829/1560-4071-2023-5502","DOIUrl":null,"url":null,"abstract":"Aim. To develop a predictive model of the risk of adverse outcomes within 12 months after myocardial infarction (MI) in patients over 70 years of age with frailty syndrome.Material and methods. This prospective observational study included 92 patients over 70 years of age with MI who were treated in the cardiology departments of Samara State Medical University Clinics from 2020 to 2021. Levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and growth stimulation expressed gene 2 (ST2) were determined in serum by enzyme-linked immunosorbent assay on day 5 of hospitalization. Frailty syndrome was identified 5th day of hospitalization using \"Age is not a hindrance\" questionnaire. The observation period was 12 months. The end point was the adverse event occurrence (all-cause death, cardiovascular death, recurrent MI, cerebrovascular accident). Statistical nonparametric methods, correlation analysis, ROC analysis, and logistic regression were used.Results. There are following significant predictors of unfavorable outcome within 12 months after MI in patients over 70 years: age over 80 years (odds ratio (OR) 5,57, 95% confidence interval (CI) 2,07-14,96, with p=0,001), history of MI (OR 3,96, 95% CI 1,36-10,26, at p<0,05), CKD-EPI glomerular filtration rate <55 ml min/1,73 m2 (OR 4,05, 95% CI 1,55-10,57, with p=0,004), pulmonary artery systolic pressure above 38 mm Hg (OR 4,5, 95% CI 1,69-11,96, with p=0,003), Simpson's left ventricular ejection fraction <45% (OR 12,21, 95% CI 4,2-35,57, with p<0,001), as well as \"Age is not a hindrance\" questionnaire score ≥3 (OR 9,62, 95% CI 2,96-31,25, with p<0,001), Charlson Comorbidity Index score ≥6 (OR 10,4, 95% CI 2,84-38,12, with p<0,001), NT-proBNP ≥1400 pg/ml (OR 7,09, 95% CI 2,53-19,89, with p<0,001) and ST2 ≥8,2 ng/ml (OR 9,13, 95% CI 2,79-29,89, p<0,001). Percutaneous coronary intervention during the current hospitalization reduced the risk of adverse outcomes (OR 0,24, 95% CI 0,09-0,69, p=0,015). Predictive model for unfavorable outcome within 12 months after MI for patients over 70 years of age based on the \"Age is not a hindrance\" questionnaire score, serum ST2 level in ng/ml and left ventricular ejection fraction in % in ROC analysis has an area under the curve of 0,87 (95% CI 0,79-0,95), sensitivity — 86%, specificity — 71% (p<0,001).Conclusion. Prediction of an unfavorable outcome based on the \"Age is not a hindrance\" questionnaire score, Simpson's left ventricular ejection fraction in %, and ST2 concentration can improve risk stratification for adverse outcomes within 12 months after MI in patients over 70 years.","PeriodicalId":21389,"journal":{"name":"Russian Journal of Cardiology","volume":" 357","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prediction of adverse outcomes within 12 months after myocardial infarction in patients over 70 years of age with frailty syndrome\",\"authors\":\"O. Aidumova, Y. Shchukin, A. O. Rubanenko\",\"doi\":\"10.15829/1560-4071-2023-5502\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Aim. To develop a predictive model of the risk of adverse outcomes within 12 months after myocardial infarction (MI) in patients over 70 years of age with frailty syndrome.Material and methods. This prospective observational study included 92 patients over 70 years of age with MI who were treated in the cardiology departments of Samara State Medical University Clinics from 2020 to 2021. Levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and growth stimulation expressed gene 2 (ST2) were determined in serum by enzyme-linked immunosorbent assay on day 5 of hospitalization. Frailty syndrome was identified 5th day of hospitalization using \\\"Age is not a hindrance\\\" questionnaire. The observation period was 12 months. The end point was the adverse event occurrence (all-cause death, cardiovascular death, recurrent MI, cerebrovascular accident). Statistical nonparametric methods, correlation analysis, ROC analysis, and logistic regression were used.Results. There are following significant predictors of unfavorable outcome within 12 months after MI in patients over 70 years: age over 80 years (odds ratio (OR) 5,57, 95% confidence interval (CI) 2,07-14,96, with p=0,001), history of MI (OR 3,96, 95% CI 1,36-10,26, at p<0,05), CKD-EPI glomerular filtration rate <55 ml min/1,73 m2 (OR 4,05, 95% CI 1,55-10,57, with p=0,004), pulmonary artery systolic pressure above 38 mm Hg (OR 4,5, 95% CI 1,69-11,96, with p=0,003), Simpson's left ventricular ejection fraction <45% (OR 12,21, 95% CI 4,2-35,57, with p<0,001), as well as \\\"Age is not a hindrance\\\" questionnaire score ≥3 (OR 9,62, 95% CI 2,96-31,25, with p<0,001), Charlson Comorbidity Index score ≥6 (OR 10,4, 95% CI 2,84-38,12, with p<0,001), NT-proBNP ≥1400 pg/ml (OR 7,09, 95% CI 2,53-19,89, with p<0,001) and ST2 ≥8,2 ng/ml (OR 9,13, 95% CI 2,79-29,89, p<0,001). Percutaneous coronary intervention during the current hospitalization reduced the risk of adverse outcomes (OR 0,24, 95% CI 0,09-0,69, p=0,015). Predictive model for unfavorable outcome within 12 months after MI for patients over 70 years of age based on the \\\"Age is not a hindrance\\\" questionnaire score, serum ST2 level in ng/ml and left ventricular ejection fraction in % in ROC analysis has an area under the curve of 0,87 (95% CI 0,79-0,95), sensitivity — 86%, specificity — 71% (p<0,001).Conclusion. Prediction of an unfavorable outcome based on the \\\"Age is not a hindrance\\\" questionnaire score, Simpson's left ventricular ejection fraction in %, and ST2 concentration can improve risk stratification for adverse outcomes within 12 months after MI in patients over 70 years.\",\"PeriodicalId\":21389,\"journal\":{\"name\":\"Russian Journal of Cardiology\",\"volume\":\" 357\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-12-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Russian Journal of Cardiology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.15829/1560-4071-2023-5502\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Russian Journal of Cardiology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.15829/1560-4071-2023-5502","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的建立70岁以上患有虚弱综合征的心肌梗死(MI)患者在术后12个月内不良预后风险的预测模型。这项前瞻性观察研究纳入了2020年至2021年期间在萨马拉国立医科大学诊所心脏科接受治疗的92名70岁以上心肌梗死患者。住院第 5 天,通过酶联免疫吸附法测定血清中 N 端前脑钠肽 (NT-proBNP) 和生长刺激表达基因 2 (ST2) 的水平。使用 "年龄不是障碍 "问卷在住院第 5 天确定虚弱综合征。观察期为 12 个月。终点为不良事件发生率(全因死亡、心血管死亡、复发性心肌梗死、脑血管意外)。研究采用了非参数统计方法、相关性分析、ROC分析和逻辑回归。70 岁以上患者在心肌梗死后 12 个月内出现不良预后的重要预测因素如下:年龄超过 80 岁(比值比 (OR) 5,57,95% 置信区间 (CI)2,07-14,96,P=0,001)、有心肌梗死病史(OR 3,96,95% CI 1,36-10,26,P<0,05)、CKD-EPI 肾小球滤过率 <55 ml min/1、73 m2(OR 4,05,95% CI 1,55-10,57,P=0,004)、肺动脉收缩压高于 38 mm Hg(OR 4,5,95% CI 1,69-11,96,P=0,003)、辛普森左心室射血分数<45%(OR 12、21,95% CI 4,2-35,57,P<0,001),以及 "年龄不是障碍 "问卷评分≥3(OR 9,62,95% CI 2,96-31,25,P<0,001)、Charlson 综合征指数评分≥6(OR 10、4,95% CI 2,84-38,12,P<0,001)、NT-proBNP ≥1400 pg/ml(OR 7,09,95% CI 2,53-19,89,P<0,001)和 ST2 ≥8,2 ng/ml(OR 9,13,95% CI 2,79-29,89,P<0,001)。在本次住院期间进行经皮冠状动脉介入治疗可降低不良预后风险(OR 0.24,95% CI 0.09-0.69,p=0.015)。基于 "年龄不是障碍 "问卷评分、血清 ST2 水平(纳克/毫升)和左心室射血分数(%)的 ROC 分析,对 70 岁以上患者心肌梗死后 12 个月内不良预后的预测模型的曲线下面积为 0.87(95% CI 0.79-0.95),灵敏度为 86%,特异度为 71%(p<0.001)。根据 "年龄不是障碍 "问卷评分、辛普森左心室射血分数(%)和 ST2 浓度预测不良预后可改善 70 岁以上患者心肌梗死后 12 个月内不良预后的风险分层。
Prediction of adverse outcomes within 12 months after myocardial infarction in patients over 70 years of age with frailty syndrome
Aim. To develop a predictive model of the risk of adverse outcomes within 12 months after myocardial infarction (MI) in patients over 70 years of age with frailty syndrome.Material and methods. This prospective observational study included 92 patients over 70 years of age with MI who were treated in the cardiology departments of Samara State Medical University Clinics from 2020 to 2021. Levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and growth stimulation expressed gene 2 (ST2) were determined in serum by enzyme-linked immunosorbent assay on day 5 of hospitalization. Frailty syndrome was identified 5th day of hospitalization using "Age is not a hindrance" questionnaire. The observation period was 12 months. The end point was the adverse event occurrence (all-cause death, cardiovascular death, recurrent MI, cerebrovascular accident). Statistical nonparametric methods, correlation analysis, ROC analysis, and logistic regression were used.Results. There are following significant predictors of unfavorable outcome within 12 months after MI in patients over 70 years: age over 80 years (odds ratio (OR) 5,57, 95% confidence interval (CI) 2,07-14,96, with p=0,001), history of MI (OR 3,96, 95% CI 1,36-10,26, at p<0,05), CKD-EPI glomerular filtration rate <55 ml min/1,73 m2 (OR 4,05, 95% CI 1,55-10,57, with p=0,004), pulmonary artery systolic pressure above 38 mm Hg (OR 4,5, 95% CI 1,69-11,96, with p=0,003), Simpson's left ventricular ejection fraction <45% (OR 12,21, 95% CI 4,2-35,57, with p<0,001), as well as "Age is not a hindrance" questionnaire score ≥3 (OR 9,62, 95% CI 2,96-31,25, with p<0,001), Charlson Comorbidity Index score ≥6 (OR 10,4, 95% CI 2,84-38,12, with p<0,001), NT-proBNP ≥1400 pg/ml (OR 7,09, 95% CI 2,53-19,89, with p<0,001) and ST2 ≥8,2 ng/ml (OR 9,13, 95% CI 2,79-29,89, p<0,001). Percutaneous coronary intervention during the current hospitalization reduced the risk of adverse outcomes (OR 0,24, 95% CI 0,09-0,69, p=0,015). Predictive model for unfavorable outcome within 12 months after MI for patients over 70 years of age based on the "Age is not a hindrance" questionnaire score, serum ST2 level in ng/ml and left ventricular ejection fraction in % in ROC analysis has an area under the curve of 0,87 (95% CI 0,79-0,95), sensitivity — 86%, specificity — 71% (p<0,001).Conclusion. Prediction of an unfavorable outcome based on the "Age is not a hindrance" questionnaire score, Simpson's left ventricular ejection fraction in %, and ST2 concentration can improve risk stratification for adverse outcomes within 12 months after MI in patients over 70 years.
期刊介绍:
Russian Journal of Cardiology has been issued since 1996. The language of this publication is Russian, with tables of contents and abstracts of all articles presented in English as well. Editor-in-Chief: Prof. Eugene V.Shlyakhto, President of the Russian Society of Cardiology.
The aim of the journal is both scientific and practical, also with referring to organizing matters of the Society. The best of all cardiologic research in Russia is submitted to the Journal. Moreover, it contains useful tips and clinical examples for practicing cardiologists. Journal is peer-reviewed, with multi-stage editing. The editorial board is presented by the leading cardiologists from different cities of Russia.