GRACE评分对75岁以上急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗预后的分析  

GRACE Score on Prognosis of ST-segment Elevation Myocardial Infarction in Patients Elder Than 75 Years With Primary Percutaneous Coronary Intervention

作　　者：叶绍东[1] 李琳[1] 王斯佳 孙中伟[1] 邱洪[1] 胡小莹[1] 丰雷[1] 慕朝伟[1] 杨跃进[1] 吴永健[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科,北京市100037 [2]首都医科大学附属北京友谊医院急诊科

出　　处：《中国循环杂志》2017年第12期1163-1166,共4页Chinese Circulation Journal

基　　金：科学化精细化多学科综合诊疗体系建立(2014-GWH03)

摘　　要：目的:探讨全球急性冠状动脉事件注册(GRACE)评分系统对75岁以上急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)短期临床获益的价值。方法:连续收集我院2011-11至2014-01之间,104例75岁以上以急性心肌梗死并行直接PCI治疗的患者,根据患者入院时GRACE评分系统将患者分为低中危组72例[GRACE评分112~154(136.5±10.6)分],高危组32例[GRACE评分155~202(167.8±12.3)分],比较两组间基线差异及结局,主要结局是1年全因死亡率。通过受试者工作特征(ROC)曲线评价GRACE评分系统预测1年死亡率的价值。生存曲线log-rank检验、单因素COX回归模型分析低中危组和高危组与结局的相关性。结果:GRACE评分系统预测1年死亡的ROC检验曲线下面积0.788,敏感性70.0%,特异性84.0%。单因素COX回归分析显示GRACE评分高危组1年死亡风险明显高于低中危组(HR=5.75,95%CI:1.486~22.256,P=0.0113)。生存曲线分析示GRACE评分高危组1年死亡率明显高于低中危组(21.9%vs 4.2%,log-rank检验P=0.0039)。结论:针对老年急性STEMI患者,GRACE评分系统可以进一步区分低中危和高危人群并具有预测1年临床预后的作用。Objective： To explore GRACE （global registry of acute coronary events）score on short term prognosis of ST-segment elevation myocardial infarction （STEMI）in patients elder than 75 years with primary percutaneous coronary intervention（PCI）. Methods： A total of 104 STEMI patients elder than 75 years with primary PCI in our hospital from 2011-11 to 2014-01 were studied. Based on GRACEscore at admission, the patients were divided into 2 groups： Lower/mid risk group, n=72 patients with GRACEscore at 112-154 （136.5±10.6） and High risk group, n=32 patients with GRACE score at 155-202（167.8±12.3）. The baseline condition and outcomes were compared between 2 groups and the primary endpoint was 1 year mortality. Predictive value of GRACEscore on 1 year mortality was evaluated by ROC curve, the relationships between Lower/mid risk group, High risk group and clinical outcomes were assessed by log-ranksurvive curve andunivariate Cox regression analysis. Results： The area under ROC curve for GRACEscore predicting 1 year mortality was 0.788 with the sensitivity at 70.0%and specificity at 84.0 %.Univariate Cox regression analysis indicated that compared with Lower/mid risk group, High risk group had the higher risk of 1-year death （HR=5.75, 95% CI 1.486-22.256, P=0.0113）; log-rank survive curve presented that High risk group had the higher 1 year mortality （21.9% vs 4.2%, P=0.0039）. Conclusion： GRACE score may further distinguish the lower/mid risk and high risk populations in elder STEMI patients; it may also predict 1 year clinical prognosis.

关 键 词：心肌梗死 老年人 血管成形术 经腔 经皮冠状动脉 GRACE评分 

分 类 号：R541[医药卫生—心血管疾病]