GRACE评分对非ST段抬高性急性冠状动脉综合征患者远期预后的评估价值  

A long -term prognostic evaluation of patients with non- ST -segment elevation acute coronary syndrome by GRACE score

作　　者：张韶辉[1,2] 王铁成[2] 王建军[2] 刘立新[2] 魏广和[2] 杨国良[2] 戴雯[3] 王乐坤 张娜娜[3] 

机构地区：[1]青岛大学医学院,山东青岛266000 [2]济宁医学院附属医院心内科,山东济宁272029 [3]济宁医学院

出　　处：《中国急救医学》2015年第7期598-602,共5页Chinese Journal of Critical Care Medicine

基　　金：济宁医学院青年基金项目（JYQ14KJ37）

摘　　要：目的明确全球急性冠状动脉事件注册（GRACE）评分对非sT段抬高性急性冠状动脉综合征（NSTE—ACS）患者出院后的远期预后评估价值。方法连续随访分析2009—01-2014—01住院诊断为NSTE—ACS的患者共895例，计算其GRACE评分。按照冠状动脉造影检查后采取的治疗方案分为三组：单纯药物治疗组（Drug组，n=463）、支架组（Stent组，n=371）和冠状动脉旁路移植术（CABG组，n=61）。生存分析采用Kaplan—Meier法；用Cox比例风险模型进行分析。计算ROC曲线下面积（AUC）评估GRACE评分对患者出院后发生心血管不良事件（MACE）的预测价值。结果研究完成随访895例，随访中位数为4．02年。在GRACE评分低危组（0—88分）、中危组（89—118分）、高危组（〉118分）中，MACE发生率分别为14．01％、36．16％及38．02％，组间比较差异有统计学意义（P〈0．01），低危组的MACE发生率相对较低。总MACE发生率在Drug组、Stent组、CABG组发生率分别为22．89％、42．43％及45．90％，组间比较差异有统计学意义（P〈0．001）。Drug组MACE发生率要低于Stent组和CABG组（P〈0．001）。ROC曲线分析发现，GRACE评分对Drag组远期预后具有诊断能力[AUC=0．676，95％CI（0．622，0．730），P〈0．01]；而对Stent组联合CABG组的远期预后无诊断能力[AUC=0．567，95％CI（0．512，0．622），P=0．17]。Cox比例回归显示，GRACE评分对NSTE—ACS的长期预后评估有重要价值。结论GRACE评分对NSTE—ACS的远期预后评估有重要价值。GRACE评分由于未将冠状动脉影像纳入而导致其预测价值下降，其对单纯药物治疗的NSTE—ACS患者远期预后（≥6个月）能够较准确的评估，但对冠状动脉支架或CABG治疗术后患者的远期预后无评估能力。Objective To determine the predictive value of GRACE score and SYNTAX score on the long - term prognosis of patients with non - ST - segment elevation acute coronary syndrome （NSTE -ACS）. Methods The data of 895 patients with NSTE - ACS between January 2009 and January 2014 were continuous follow- up analyzed, and their GRACE score was calculated, Patients were divided into three groups： Drug group （n = 463）, Stentt group （n = 371 ） and CABG group （n = 61 ）. Kaplan - Meier method was used for Survival analysis, and Cox proportional hazards model was used to the univariate analysis. Area under curve （AUC） of ROC analysis was used to compare the two methods. Results 895 cases of complete follow - up and a median follow - up of 4.02 years. In the GRACE score low risk group （0 to 88）, intermediate risk group （89 to 118） and high - risk group （ 〉118）, MACE rates were respectively 14.01%, 36. 16% and 38.02%, there were significant differences between the groups （P 〈0.01 ）, MACE incidence in the low -risk group was relatively low. The overall MACE incidence rates for the Drug group, Stent group and CABG group were 22.89%,42.43% and 45.90%, a significant difference between the three groups （P 〈 0.001 ）. The incidence of MACE in the Drug group was lower than the Stent group and the CABG group （P 〈0.001 ）. ROC curve analysis, GRACE score on long - term prognosis of Drug group had diagnostic capabilities [ AUC = 0. 676, 95% CI （0.622, 0.730）, P 〈0.01 ] ; and had no diagnosis ability in the Stent group combined CABG group [ AUC = 0. 567, 95% CI （0. 512, 0. 622）, P = 0. 17 1. Cox proportional regression analysis showed that GRACE score had an important value for the long - term prognosis of NSTE - ACS. Conclusion GRACE score has an important value for the long - term prognosis of NSTE - ACS. Because GRACE score not included the angiographic and led to its predictive value decreased. GRACE score can be more accurate for the long - term prognosis in the patients wi

关 键 词：冠心病 非ST段抬高性急性冠状动脉综合征 GRACE评分 预后评估 

分 类 号：R541[医药卫生—心血管疾病]