Poređenje prediktivne vrednosti pet skorova rizika kod bolesnika sa infarktom miokarda lečenih primarnom perkutanom koronarnom intervencijom
Sažetak
Sažetak
Uvod: Mortalitet bolesnika sa akutnim infarktom miokarda (AIM) lečenih metodom primarne perkutane koronarne intervencije (pPCI) je uprkos napretku standarda lečenja i dalje kratkoročno i dugoročno gledano relativno visok. Stratifikacija bolesnika prema riziku od smrtnog ishoda je od izuzetnog dijagnostičkog, terapeutskog i prognostičkog značaja. Do danas, razvijeno je nekoliko skorova rizika, međutim mali broj do sada sprovedenih studija je poredio efikasnost ovih skorova u predikciji dugoročnog mortaliteta.
Cilj: Poređenje pet skorova rizika, u pogledu predikcije dugoročne smrtnosti, na populaciji bolesnika sa akutnim infarktom miokarda lečenih pPCI u sali za kateterizaciju srca Kliničkog centra Srbije.
Materijal i metode: U retrospektivnoj studiji obuhvaćeno je 497 konsekutivnih bolesnika sa dijagnozom AIM, lečeni pPCI, u toku 2012. godine. Za svakog bolesnika izračunata je vrednost sledećih skorova za procenu rizika: CADILLAC, ZWOLLE, ACEF, TIMI i PAMI. Prognostička sposobnost skorova rizika je procenjena na osnovu površine (AUC) ispod ROC (“receiver – operating characteristics”) krivih.
Zaključak: CADILLAC skor rizika je pokazao najbolju prediktivnu vrednost za dugoročnu smrtnost u periodu praćenja od tri godine u ispitivanoj populaciji bolesnika sa AIM lečenih pPCI među testiranim modelima.
Ključni pojmovi: Akutni infarkt miokarda, primarna PCI, prognoza rizika, udaljeno kliničko praćenje bolesnika
Abstract
Introduction: Mortality of patients with acute myocardial infarction (AMI) treated by primary PCI (pPCI) is relatively high when short and long term-outcomes are concerned, despite the progress of standard of care. The stratification of patients according to risk of death is of great diagnostic, therapeutic and prognostic significance. Several risk scores have been developed, however only a few studies so far investigated the efficacy of these scores in predicting long-term mortality.
Aim: The aim of study was to compare the predictive value of five risk scores, regarding long-term mortality among patients with AMI treated with pPCI in the Clinical Center of Serbia.
Methods: We performed a retrospective study that included 497 consecutive patients with a diagnosis of AMI treated with pPCI in 2012. For every patient, the value of CADILLAC, ZWOLLE, ACEF, TIMI and PAMI scores was calculated. Prognostic ability of risk scores was compared by area under (AUC) the ROC (receiver-operating characteristics) curve.
Conclusion: CADILLAC risk score showed the best predictive ability regarding mortality up to three years in a population of AMI patients treated with pPCI.
Key words: Acute myocardial infarction, primary PCI, risk prediction, long-term clinical outcomes
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