https://scholars.lib.ntu.edu.tw/handle/123456789/553722
標題: | Rapid early triage by leukocytosis and the thrombolysis in myocardial infarction (TIMI) risk score for st-elevation myocardial infarction undergoing primary percutaneous coronary intervention an observational study | 作者: | Yeh Y.-T. Liu C.-W. Li A.-H. Ke S.-R. Liu Y.-H. Chen K.-C. Liao P.-C. YEN-WEN WU |
公開日期: | 2016 | 卷: | 95 | 期: | 7 | 來源出版物: | Medicine (United States) | 摘要: | The clinical utility of leukocytosis in risk assessment for ST-elevation myocardial infarction (STEMI) is still unclear. We aim to demonstrate the prognostic value of leukocyte counts independent from traditional risk factors and the TIMI risk score (TRS) for STEMI and to propose a practical model comprising leukocyte count for early triage in STEMI undergoing primary angioplasty. A prospective database (n=796) of consecutive STEMI cases receiving primary angioplasty at a tertiary medical center was retrospectively analyzed in the period from February 1, 2007 through December 31, 2012. Primary endpoints were 30-day and 1-year mortality. Propensity score-adjusted Cox regression models and subdivision analysis were performed. Leukocytosis group (n=306) had higher 30-day mortality (5.9% vs 3.1%, P=0.048) and 1-year mortality (9.2% vs 5.1%, P=0.022). After adjustment by propensity score and TRS, leukocyte count (per 103/mL) was an independent predictor of 1-year mortality (HR: 1.086, 95% CI: 1.034-1.140, P=0.001). Subdivision analysis demonstrated the correlation between leukocytosis and higher 1-year mortality within both high and low TRS strata (divided by 4, the median of TRS). Additionally, 24% (191 out of 796) of patients were characterized by nonleukocytosis and TRS<4, having 0% of mortality rate at 1-year follow-up. In conclusion, leukocyte count is an independent prognostic factor adding incremental value to TRS for STEMI. Nonleukocytosis in conjunction with TRS<4 identifies a large patient group at extremely low risk and thus provides rapid early triage for STEMI patients undergoing primary PCI. This finding is worth validation in the future. ? 2016 Wolters Kluwer Health, Inc. All rights reserved. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/553722 | ISSN: | 0025-7974 | DOI: | 10.1097/MD.0000000000002857 | SDG/關鍵字: | acetylsalicylic acid; angiotensin receptor antagonist; beta adrenergic receptor blocking agent; clopidogrel; dipeptidyl carboxypeptidase inhibitor; hemoglobin; hydroxymethylglutaryl coenzyme A reductase inhibitor; triacylglycerol; adult; age; aged; Article; cardiovascular disease assessment; cardiovascular risk; clinical feature; comparative study; controlled study; dyslipidemia; emergency health service; female; follow up; heart infarction size; hemoglobin blood level; hospital admission; human; hypertension; leukocyte count; leukocytosis; major clinical study; male; medical history; mortality rate; observational study; percutaneous coronary intervention; priority journal; prognosis; prognostic assessment; retrospective study; risk assessment; scoring system; sex difference; smoking; ST segment elevation myocardial infarction; Thrombolysis in Myocardial Infarction risk score; triacylglycerol blood level; emergency health service; immunology; middle aged; Myocardial Infarction; percutaneous coronary intervention; propensity score; severity of illness index; Aged; Female; Humans; Leukocyte Count; Male; Middle Aged; Myocardial Infarction; Percutaneous Coronary Intervention; Propensity Score; Retrospective Studies; Risk Assessment; Severity of Illness Index; Triage |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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