GRACE评分对急性心肌梗死患者主要心脑血管不良事件与出血事件预测价值  

Predictive value of GRACE risk score model for the main adverse cardiovascular and cerebrovascular events bleeding events in the patients with acute myocardial infraction

作　　者：王艳霞[1] 郑凌飞[1] 方毅[1] 关明子 李毅[1] 

机构地区：[1]沈阳军区总医院心血管病研究所心血管内科,辽宁沈阳110016

出　　处：《临床军医杂志》2017年第6期608-611,共4页Clinical Journal of Medical Officers

摘　　要：目的研究GRACE评分对急性心肌梗死(AMI)患者1年内主要心脑血管不良事件(MACCE)与出血事件的预测价值。方法回顾性分析2009-2013年收治的6 787例AMI患者的临床资料,应用GRACE评分将患者分为低危组(评分≤88分)、中危组(89~118分)及高危组(评分>118分)。随访患者1年,记录1年内MACCE[包括全因死亡、心肌梗死、缺血性卒中及靶血管血运重建(TVR)]与出血事件发生情况,应用生存曲线计算累积发生风险,评价GRACE评分对AMI患者MACCE与出血事件的预测价值。结果 1年内发生MACCE 361例(5.32%),其中,全因死亡167例(2.46%)、心肌梗死65例(0.96%)、TVR 105例(1.55%)及缺血性卒中24例(0.35%);发生出血事件91例(1.34%)。单支与三支病变、全因死亡与心肌梗死的发生概率随着GRACE评分的增加而显著增加,差异有统计学意义(P<0.05)。MACCE与出血事件的累积发生风险随着GRACE评分的增加而显著增加,差异有统计学意义(P<0.05)。结论 GRACE评分对AMI患者出院后1年内MACCE具有较高的预测价值,对出血事件也具有一定的预测价值。Objective To analyze the predictive value of the GRACE risk score for the major adverse cardiac and cerebrovascular e- vents （MACCE）and bleeding events at 1 year in the patients with acute myocardial infraction（AMI）. Methods A retrospective study was performed on 6 787 patients diagnosed as AMI who were admitted from 2009 to 2013. These patients were scored according to GRACE risk score and were divided into three groups ：low risk group（ less than 88 points） ,medium risk group（ more than 89 points, less than 118 points）and high risk group（ more than 118 points）. The incidence of MACCE[ including all cause death, myocardial in- farction, ischemic stroke and target blood vessels reascularization（TVR） ] and the bleeding events at 1 year after discharge was calcu- lated. The predictive value of GRACE risk score for these adverse events were analyzed. Results A total of 361 cases （5.32%） of MACCE and 91 cases（ 1.34% ） of bleeding events were occurred within lyear after discharge. Of all the MACCE,there were 167 cases （ 2.46% ） of all cause death,65 cases （0. 96% ） of MI, 105 cases （ 1.55 % ） of TVR and 24 Cases （0. 35 % ） of ischemic stroke. The inci- dences of single and three-vessel diseases, all cause death and cardiac death were increased significantly with the increase of GRACE score（P 〈 0.05）. The cumulative risk of MACCE and bleeding events were increased significantly with the increase of GRACE score （P 〈 0. 05）. Conclusion GRACE risk score has a high predictive value for the MACCE in the patients with AMI at 1 year after dis- charge, and also has certain predictive value for bleeding events.

关 键 词：急性心肌梗死 主要心脑血管不良事件 出血事件 GRACE评分 

分 类 号：R473.5[医药卫生—护理学]