CREST评分预测院外心脏骤停无STEMI时循环病因性死亡的验证

IF 1.3 American journal of cardiovascular disease Pub Date : 2021-12-15 eCollection Date: 2021-01-01
Timothy N Jones, Matthew Kelham, Krishnaraj S Rathod, Charles J Knight, Alastair Proudfoot, Ajay K Jain, Andrew Wragg, Muhiddin Ozkor, Paul Rees, Oliver Guttmann, Andreas Baumbach, Anthony Mathur, Daniel A Jones
{"title":"CREST评分预测院外心脏骤停无STEMI时循环病因性死亡的验证","authors":"Timothy N Jones,&nbsp;Matthew Kelham,&nbsp;Krishnaraj S Rathod,&nbsp;Charles J Knight,&nbsp;Alastair Proudfoot,&nbsp;Ajay K Jain,&nbsp;Andrew Wragg,&nbsp;Muhiddin Ozkor,&nbsp;Paul Rees,&nbsp;Oliver Guttmann,&nbsp;Andreas Baumbach,&nbsp;Anthony Mathur,&nbsp;Daniel A Jones","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>The CREST tool was recently developed to stratify the risk of circulatory-aetiology death (CED) in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation myocardial infarction (STEMI). We aimed to validate the CREST score using an external cohort and determine whether it could be improved by the addition of serum lactate on admission.</p><p><strong>Methods: </strong>The study involved the retrospective analysis of consecutive patients admitted to a single tertiary centre with OHCA of presumed cardiac origin over a 51-month period. The CREST score was calculated by attributing points to the following variables: Coronary artery disease (CAD), non-shockable Rhythm, Ejection fraction <30%, cardiogenic Shock at presentation and ischaemic Time ≥25 minutes. The primary endpoint was CED vs neurological aetiology death (NED) or survival.</p><p><strong>Results: </strong>Of 500 patients admitted with OHCA, 211 did not meet criteria for STEMI and were included. 115 patients died in hospital (71 NED, 44 CED). When analysed individually, CED was associated with all CREST variables other than a previous diagnosis of CAD. The CREST score accurately predicted CED with excellent discrimination (C-statistic 0.880, 95% CI 0.813-0.946) and calibration (Hosmer and Lemeshow P=0.948). Although an admission lactate ≥7 mmol/L also predicted CED, its addition to the CREST score (the C-AREST score) did not significantly improve the predictive ability (CS 0.885, 0.815-0.954, HS P=0.942, X<sup>2</sup> difference in -2 log likelihood =0.326, P=0.850).</p><p><strong>Conclusion: </strong>Our study is the first to independently validate the CREST score for predicting CED in patients presenting with OHCA without STEMI. Addition of lactate on admission did not improve its predictive ability.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8784677/pdf/ajcd0011-0723.pdf","citationCount":"0","resultStr":"{\"title\":\"Validation of the CREST score for predicting circulatory-aetiology death in out-of-hospital cardiac arrest without STEMI.\",\"authors\":\"Timothy N Jones,&nbsp;Matthew Kelham,&nbsp;Krishnaraj S Rathod,&nbsp;Charles J Knight,&nbsp;Alastair Proudfoot,&nbsp;Ajay K Jain,&nbsp;Andrew Wragg,&nbsp;Muhiddin Ozkor,&nbsp;Paul Rees,&nbsp;Oliver Guttmann,&nbsp;Andreas Baumbach,&nbsp;Anthony Mathur,&nbsp;Daniel A Jones\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>The CREST tool was recently developed to stratify the risk of circulatory-aetiology death (CED) in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation myocardial infarction (STEMI). We aimed to validate the CREST score using an external cohort and determine whether it could be improved by the addition of serum lactate on admission.</p><p><strong>Methods: </strong>The study involved the retrospective analysis of consecutive patients admitted to a single tertiary centre with OHCA of presumed cardiac origin over a 51-month period. The CREST score was calculated by attributing points to the following variables: Coronary artery disease (CAD), non-shockable Rhythm, Ejection fraction <30%, cardiogenic Shock at presentation and ischaemic Time ≥25 minutes. The primary endpoint was CED vs neurological aetiology death (NED) or survival.</p><p><strong>Results: </strong>Of 500 patients admitted with OHCA, 211 did not meet criteria for STEMI and were included. 115 patients died in hospital (71 NED, 44 CED). When analysed individually, CED was associated with all CREST variables other than a previous diagnosis of CAD. The CREST score accurately predicted CED with excellent discrimination (C-statistic 0.880, 95% CI 0.813-0.946) and calibration (Hosmer and Lemeshow P=0.948). Although an admission lactate ≥7 mmol/L also predicted CED, its addition to the CREST score (the C-AREST score) did not significantly improve the predictive ability (CS 0.885, 0.815-0.954, HS P=0.942, X<sup>2</sup> difference in -2 log likelihood =0.326, P=0.850).</p><p><strong>Conclusion: </strong>Our study is the first to independently validate the CREST score for predicting CED in patients presenting with OHCA without STEMI. Addition of lactate on admission did not improve its predictive ability.</p>\",\"PeriodicalId\":7427,\"journal\":{\"name\":\"American journal of cardiovascular disease\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2021-12-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8784677/pdf/ajcd0011-0723.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of cardiovascular disease\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of cardiovascular disease","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

目的:CREST工具是最近开发的,用于对院外心脏骤停(OHCA)患者无st段抬高型心肌梗死(STEMI)的循环病因性死亡(CED)风险进行分层。我们的目的是通过外部队列验证CREST评分,并确定是否可以通过在入院时添加血清乳酸来改善CREST评分。方法:本研究回顾性分析了在单一三级中心连续收治的51个月推定心源性OHCA患者。CREST评分通过以下变量计算:冠状动脉疾病(CAD)、非休克性心律、射血分数结果:在500例OHCA患者中,211例不符合STEMI标准,并被纳入。115例患者在医院死亡,其中急诊71例,急症44例。当单独分析时,除了先前的CAD诊断外,CED与所有CREST变量相关。CREST评分准确预测CED具有良好的判别性(c -统计量0.880,95% CI 0.813-0.946)和校准(Hosmer和Lemeshow P=0.948)。入院时乳酸≥7 mmol/L对CED也有预测作用,但与CREST评分(C-AREST评分)加在一起对CED的预测能力无显著提高(CS = 0.885, 0.815-0.954, HS P=0.942, X2差值-2对数似然=0.326,P=0.850)。结论:我们的研究是第一个独立验证CREST评分预测无STEMI OHCA患者的CED的研究。入院时添加乳酸并没有提高其预测能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

摘要图片

摘要图片

分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Validation of the CREST score for predicting circulatory-aetiology death in out-of-hospital cardiac arrest without STEMI.

Aims: The CREST tool was recently developed to stratify the risk of circulatory-aetiology death (CED) in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation myocardial infarction (STEMI). We aimed to validate the CREST score using an external cohort and determine whether it could be improved by the addition of serum lactate on admission.

Methods: The study involved the retrospective analysis of consecutive patients admitted to a single tertiary centre with OHCA of presumed cardiac origin over a 51-month period. The CREST score was calculated by attributing points to the following variables: Coronary artery disease (CAD), non-shockable Rhythm, Ejection fraction <30%, cardiogenic Shock at presentation and ischaemic Time ≥25 minutes. The primary endpoint was CED vs neurological aetiology death (NED) or survival.

Results: Of 500 patients admitted with OHCA, 211 did not meet criteria for STEMI and were included. 115 patients died in hospital (71 NED, 44 CED). When analysed individually, CED was associated with all CREST variables other than a previous diagnosis of CAD. The CREST score accurately predicted CED with excellent discrimination (C-statistic 0.880, 95% CI 0.813-0.946) and calibration (Hosmer and Lemeshow P=0.948). Although an admission lactate ≥7 mmol/L also predicted CED, its addition to the CREST score (the C-AREST score) did not significantly improve the predictive ability (CS 0.885, 0.815-0.954, HS P=0.942, X2 difference in -2 log likelihood =0.326, P=0.850).

Conclusion: Our study is the first to independently validate the CREST score for predicting CED in patients presenting with OHCA without STEMI. Addition of lactate on admission did not improve its predictive ability.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
American journal of cardiovascular disease
American journal of cardiovascular disease CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
0.00%
发文量
21
期刊最新文献
A diagnostic prediction model for the early detection of heart failure following primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction. A normal and particularly small (<35 mm) left atrial size measured during echocardiography suggests low likelihood of moderate or severe left ventricular systolic dysfunction. Exploring the impact of metabolites function on heart failure and coronary heart disease: insights from a Mendelian randomization (MR) study. Impact of risk factors on intervened and non-intervened coronary lesions. Investigating the effect of cancer medication in the development of Takotsubo cardiomyopathy.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1