CHA_(2)DS_(2)-VASc评分对急性ST段抬高型心肌梗死患者近期预后的预测价值  

Predictive Value of the CHA_(2)DS_(2)-VASc Score for 30-day Outcomes in Patients With Acute ST-segment Elevation Myocardial Infarction

作　　者：吕思奇 杨艳敏[1] 朱俊[1] 张晗[1] 邵兴慧[1] 王娟[1] 吴双[1] 任佳梦 刘力生[2] LYU Siqi;YANG Yanmin;ZHU Jun;ZHANG Han;SHAO Xinghui;WANG Juan;WU Shuang;REN Jiameng;LIU Lisheng(Emergency and Critical Care Center,National Center for Cardioavscular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing 100037,China)

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,阜外医院急重症中心,北京市100037 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院高血压中心,北京市100037

出　　处：《中国循环杂志》2021年第3期251-257,共7页Chinese Circulation Journal

基　　金：国家重点研发计划(2017YFC0908800)。

摘　　要：目的:本研究旨在探索CHA_(2)DS_(2)-VASc评分对急性ST段抬高型心肌梗死(STEMI)患者近期预后的预测价值。方法:回顾性分析7476例中国急性STEMI患者的基线及随访资料,按CHA_(2)DS_(2)-VASc评分将患者分为1分组(n=1815)、2~3分组(n=3585)、≥4分组(n=2076)。主要终点为30 d全因死亡,次要终点包括30 d再发心肌梗死、心原性休克、脑卒中及主要不良心血管事件(包括全因死亡、再发心肌梗死、恶性心律失常、心力衰竭和脑卒中)。应用单因素和多因素Cox回归分析评估CHA_(2)DS_(2)-VASc评分对急性STEMI患者30 d终点事件的影响。通过绘制ROC曲线,评估CHA_(2)DS_(2)-VASc评分对急性STEMI患者30 d死亡风险的预测价值。结果:与低CHA2DS2-VASc评分患者相比,高CHA_(2)DS_(2)-VASc评分患者的病情更重,合并症更多,而接受再灌注治疗及规范药物治疗的患者比例更低(P均<0.05)。随着CHA_(2)DS_(2)-VASc评分升高,急性STEMI患者30 d全因死亡率(1分组、2~3分组、≥4分组分别为2.0%、8.0%、23.7%)及再发心肌梗死、心原性休克、脑卒中、主要不良心血管事件的发生率均显著升高(P均<0.001)。多因素Cox回归分析显示,CHA_(2)DS_(2)-VASc评分是上述终点事件的独立预测因素。ROC曲线显示,在预测30 d全因死亡风险上,CHA2DS2-VASc评分的AUC与TIMI评分(0.756 vs.0.767)和GRACE评分(0.756 vs.0.769)间的差异均无统计学意义(P均>0.05)。结论:CHA_(2)DS_(2)-VASc评分是急性STEMI患者30 d终点事件的独立预测因素,其对急性STEMI患者30 d全因死亡风险的预测能力与TIMI评分和GRACE评分相当,且计算简单,可考虑用于急性STEMI患者的早期风险评估。Objectives:This study aims to explore the predictive value of the CHA_(2)DS_(2)-VASc score for 30-day outcomes of patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:We retrospectively analyzed the data of 7476 Chinese patients with acute STEMI.Patients were divided into 3 groups according to the CHA_(2)DS_(2)-VASc score(1,2-3 and≥4 scores).The primary endpoint was 30-day all-cause mortality,while the secondary endpoints included recurrent myocardial infarction,cardiogenic shock,stroke,and major adverse cardiovascular events(MACE,including all-cause mortality,recurrent myocardial infarction,malignant arrythmias,heart failure and stroke).Univariate and multivariate Cox regression were performed to evaluate the associations between the CHA_(2)DS_(2)-VASc score and 30-day endpoints.The ROC curves were constructed,and the AUC was used to evaluate the predictive value of the CHA2DS2-VASc score for 30-day all-cause mortality.Results:Compared to those with lower CHA_(2)DS_(2)-VASc scores,patients with higher CHA_(2)DS_(2)-VASc scores tended to have more comorbidities but receive less reperfusion therapy and standard medications(all P<0.05).With the elevation of CHA_(2)DS_(2)-VASc score,the incidence of 30-day all-cause death(2.0%,8.0%,23.7%in 1 score group,2-3 scores group,≥4 scores group,respectively),recurred myocardial infarction,cardiogenic shock,stroke and MACE increased significantly(all P<0.001).Multivariate Cox regression analysis indicated that CHA_(2)DS_(2)-VASc score was an independent predictor of 30-day all-cause death,recurred myocardial infarction,cardiogenic shock,stroke and MACE.For 30-day mortality,the AUC of the CHA2DS2-VASc score was comparable with the TIMI score(0.756 vs.0.767,P=0.150)and the GRACE score(0.756 vs.0.769,P=0.166).Conclusions:The CHA_(2)DS_(2)-VASc score is an independent predictor of 30-day endpoints in patients with acute STEMI.Its predictive value for 30-day mortality were comparable with the TIMI score and the GRACE score,which could be used as a simp

关 键 词：急性ST段抬高型心肌梗死 CHA_(2)DS_(2)-VASc评分 全因死亡 风险评估 

分 类 号：R54[医药卫生—心血管疾病]