验证 CREST 模型并与 SCAI 休克分类进行比较,以预测院外心脏骤停复苏者的体外循环死亡。

IF 3.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Samuel A Watson, Shamika Mohanan, Muhamad Abdrazak, Roman Roy, Alexandra Parczewska, Ritesh Kanyal, Michael McGarvey, Rafal Dworakowski, Ian Webb, Kevin O'Gallagher, Narbeh Melikian, Georg Auzinger, Sameer Patel, Miłosz J Jaguszewski, Daniel Stahl, Ajay Shah, Philip MacCarthy, Jonathan Byrne, Nilesh Pareek
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引用次数: 0

摘要

目的:我们对 CREST 模型进行了验证,该模型是用于对院外心脏骤停(OHCA)后循环病因死亡(CED)风险进行分层的 5 个变量评分,并将其与 SCAI 休克分类进行了比较:背景:约三分之一的 OHCA 复苏后入院患者会出现 CED。目前急需对抵达心脏骤停中心的 OHCA 患者进行更好的分层,以改进对患者进行有创干预的选择:方法:2012 年 5 月至 2020 年 12 月期间,CREST 模型和 SCAI 休克分类被应用于一项双中心登记,登记对象为 723 名心源性 OHCA 患者,既包括 ST 段抬高型心肌梗死患者,也包括非 ST 段抬高型心肌梗死患者。主要终点是30天CED:在纳入的 509 名患者(62.3 岁,75.4% 为男性)中,125 名患者 CREST=0 (24.5%),162 名患者 CREST=1 (31.8%),140 名患者 CREST=2 (27.5%),75 名患者 CREST=3 (14.7%),7 名患者 CREST=4 (1.4%),没有患者 CREST=5。在 30 天内,91 名患者(17.9%)观察到 CED [STEMI - 51/289 (17.6%);NSTEMI - 40/220 (18.2%)]。在总人群、NSTEMI 和 STEMI 亚人群中,CREST 评分的增加与 CED 的增加相关(所有 p 结论:CREST模型和SCAI休克分类对OHCA后CED的发展具有相似的预测作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Validation of the CREST model and comparison with SCAI shock classification for the prediction of circulatory death in resuscitated out-of-hospital cardiac arrest.

Aims: We validated the CREST model, a 5 variable score for stratifying the risk of circulatory aetiology death (CED) following out-of-hospital cardiac arrest (OHCA) and compared its discrimination with the SCAI shock classification. Circulatory aetiology death occurs in approximately a third of patients admitted after resuscitated OHCA. There is an urgent need for improved stratification of the patient with OHCA on arrival to a cardiac arrest centre to improve patient selection for invasive interventions.

Methods and results: The CREST model and SCAI shock classification were applied to a dual-centre registry of 723 patients with cardiac aetiology OHCA, both with and without ST-elevation myocardial infarction (STEMI), between May 2012 and December 2020. The primary endpoint was a 30-day CED. Of 509 patients included (62.3 years, 75.4% male), 125 patients had CREST = 0 (24.5%), 162 had CREST = 1 (31.8%), 140 had CREST = 2 (27.5%), 75 had CREST = 3 (14.7%), 7 had a CREST of 4 (1.4%), and no patients had CREST = 5. Circulatory aetiology death was observed in 91 (17.9%) patients at 30 days [STEMI: 51/289 (17.6%); non-STEMI (NSTEMI): 40/220 (18.2%)]. For the total population, and both NSTEMI and STEMI subpopulations, an increasing CREST score was associated with increasing CED (all P < 0.001). The CREST score and SCAI classification had similar discrimination for the total population [area under the receiver operating curve (AUC) = 0.72/calibration slope = 0.95], NSTEMI cohort (AUC = 0.75/calibration slope = 0.940), and STEMI cohort (AUC = 0.69 and calibration slope = 0.925). Area under the receiver operating curve meta-analyses demonstrated no significant differences between the two classifications.

Conclusion: The CREST model and SCAI shock classification show similar prediction results for the development of CED after OHCA.

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来源期刊
CiteScore
8.50
自引率
4.90%
发文量
325
期刊介绍: The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.
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