HEART风险评分在老年急性胸痛人群中的应用价值  

Application value of HEART risk score in the elderly patients with acute chest pain

作　　者：马春朋[1] 刘晓丽[2] 朱爱红[1] 董雪飞[1] 马春明[2] 聂绍平[3] Ma Chunpeng;Liu Xiaoli;Zhu Aihong;Dong Xuefei;Ma Chunming;Nie Shaoping(Department of Cardiology,the First Hospital of Qinhuangdao,Qinhuangdao 066000,China;Department of Endocrinology,the First Hospital of Qinhuangdao,Qinhuangdao 066000,China;Emergency&Critical Care Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]秦皇岛市第一医院心内科,066000 [2]秦皇岛市第一医院内分泌科,066000 [3]首都医科大学附属北京安贞医院急诊危重症中心,100029

出　　处：《中国心血管杂志》2020年第6期516-519,共4页Chinese Journal of Cardiovascular Medicine

基　　金：河北省卫生健康委员会医学科学研究课题计划(20201318)。

摘　　要：目的探讨HEART风险评分在老年急性胸痛人群中的应用价值。方法利用已有急性胸痛数据库进行回顾性分析。连续入选2014年9月至2015年2月于首都医科大学附属北京安贞医院急诊胸痛中心就诊的老年急性胸痛患者,计算HEART风险评分。研究终点为患者就诊后3个月内的主要不良心血管事件(MACE)。结果研究期间共有1735例急性胸痛患者来诊,最终入选389例老年急性胸痛患者,其中190例(48.8%)发生MACE。HEART风险评分的范围为2~10分,平均(5.7±1.4)分。在全部老年患者中,HEART风险评分的受试者工作特征(ROC)曲线下面积(AUC)为0.73(95%CI:0.68~0.78),在糖尿病和非糖尿病患者中分别为0.72(95%CI:0.63~0.81)和0.73(95%CI:0.67~0.79),在女性和男性患者中分别为0.76(95%CI:0.69~0.83)和0.70(95%CI:0.64~0.77),在既往有冠心病患者和无冠心病患者中分别为0.68(95%CI:0.64~0.77)和0.77(95%CI:0.71~0.83)。将入选患者分为3组:低危组(评分2~3分)、中危组(评分4分)和高危组(评分5~10分),MACE发生率分别为6.7%(1/15)、22.6%(12/53)和55.1%(177/321),各组间比较差异有统计学意义(χ^2=30.26,P<0.001)。结论HEART风险评分可有助于老年急性胸痛人群的危险分层和处理策略选择。Objective To study the application value of HEART risk score in the elderly patients with acute chest pain.Methods We used existing acute chest pain database for retrospective analysis.Elderly patients with acute chest pain admitted to the emergency department of Beijing Anzhen Hospital from September 2014 to July 2015 were enrolled.Data recorded on arrival at the emergency department were used.Baseline characteristics of patients were included.The HEART risk score was calculated.The endpoint of the study was the major adverse cardiovascular event(MACE)including acute myocardial infarction,percutaneous coronary intervention,coronary artery bypass graft,and all-cause death within 3 months after initial presentation.Results During the study period,a total of 1735 patients with acute chest pain came to the clinic,and finally 389 elderly patients with acute chest pain were enrolled,of which 190 cases(48.8%)had MACE within 3 months.HEART risk score of elderly patients ranged from 2 to 10 points,with an average of(5.7±1.4)points.The area under the receiver operating characteristic(ROC)curve was 0.73(95%CI:0.68-0.78)in all elderly patients.The area under the ROC curve was 0.72(95%CI:0.63-0.81)in diabetes mellitus patients and 0.73(95%CI:0.67-0.79)in non-diabetes mellitus patients,respectively.The area under the ROC curve was 0.76(95%CI:0.69-0.83)in female patients and 0.70(95%CI:0.64-0.77)in male patients,respectively.The area under the ROC curve was 0.68(95%CI:0.63-0.77)in patients with coronary heart disease and 0.77(95%CI:0.71-0.83)in patients without coronary heart disease,respectively.Patients were categorized into three groups:low risk(score 2-3),intermediate risk(score 4),and high risk(score 5-10);MACE rates were 6.7%(1/15),22.6%(12/53)and 55.1%(177/321),respectively(χ^2=30.26,P<0.001).Conclusions The HEART risk score can help the risk stratification and treatment strategy selection of elderly patients with acute chest pain in the emergency department.

关 键 词：老年人 胸痛 急性冠状动脉综合征 急诊处理 风险评分 

分 类 号：R54[医药卫生—心血管疾病]