HEART评分在合并动脉粥样硬化性心血管病的非ST段抬高型急性胸痛人群的应用价值  

HEART risk score in acute chest pain patients with atherosclerotic car-diovascular disease in the emergency department

作　　者：马春朋[1] 刘晓丽[2] 董雪飞[1] 马利祥[1] 朱爱红[1] 蔡丽丽[1] 聂绍平[3] MA Chunpeng;LIU Xiaoli;DONG Xuefei;MA Lixiang;ZHU Aihong;CAI Lili;NIE Shaoping(Department of Cardiology,the First Hospital of Qinhuangd-ao,Qinhuangdao Hebei 066000,China)

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

出　　处：《中国急救复苏与灾害医学杂志》2021年第12期1362-1366,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省医学科学研究课题计划(编号:20201318)。

摘　　要：目的研究HEART风险评分在合并动脉粥样硬化性心血管病的非ST段抬高型急性胸痛人群的应用价值。方法连续入选2014年9月-2015年6月来急诊科就诊的胸痛患者,收集患者到达急诊科时的数据,并建立胸痛数据库,进行回顾性分析,计算HEART风险。研究终点为随访3个月时发生的主要不良心脏事件(急性心肌梗死、冠状动脉介入治疗、冠状动脉搭桥术或全因死亡组成的复合终点)。结果研究期间有1735名急性胸痛患者就诊,入选477名合并动脉粥样硬化性心血管病的疑诊急性缺血性胸痛患者。241名患者发生301个主要不良心脏事件,其中65名患者发生AMI,172名患者行经皮冠状动脉介入治疗术(PCI),59名患者行冠状动脉搭桥术(CABG),5名患者死亡。HEART风险评分为2~10分。HEART风险评分的受试者操作特征曲线下面积为0.73(95%置信区间:0.68~0.77)。所有入选患者被分成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),主要不良心脏事件发生率分别为6.7%(1/15),21.1%(18/85)和58.9%(222/377),各组间具有统计学差异(P<0.001)。依据不同危险分层,采取不同分诊策略。结论HEART风险评分可用在合并动脉粥样硬化性心血管疾病的非ST段抬高型急性胸痛人群的危险分层和处置策略选择。Objective To study the HEART risk score in acute chest pain patients with non-ST segment elevation and atherosclerotic cardiovascular disease in the emergency department.Methods This study was based on an acquired da⁃tabase.Patients with acute chest pain who was admitted to the emergency department of Beijing Anzhen Hospital from September 2014 to July 2015 were selected.Data recorded on arrival in the emergency department were collected.The serum sample of high-sensitivity Troponin I was detected.The HEART risk score was calculated.The endpoint(major adverse cardiovascular events,MACE)was a composite of acute myocardial infarction,percutaneous coronary interven⁃tion,coronary artery bypass graft,and all-cause death within 3 months after initial presentation.Results The study pop⁃ulation included 1735 consecutive chest pain patients.Finally,477 eligible patients with suspected ischemic origin and atherosclerotic cardiovascular disease were enrolled.241 patients(50.5%)had 301 MACEs within 3 months.HEART so⁃cre ranged from 2 to 10.A significant progressive pattern of increasing MACE rate was observed as the score increased(P<0.001 by chi-square for trend).The area under the receiver operating characteristic(ROC)curve was 0.73(95%CI:0.68~0.77)in all patients.The area under the ROC curve was 0.73(95%CI:0.68~0.77)in female patients and 0.74(95%CI:0.69~0.79)in male patients,respectively.The area under the ROC curve was 0.70(95%CI:0.63~0.77)in aged patients and 0.78(95%CI:0.74~0.84)in non-aged patients,respectively.The area under the ROC curve was 0.75(95%CI:0.68~0.83)in diabetes mellitus patients and 0.72(95%CI:0.66~0.78)in non-diabetes mellitus patients,respective⁃ly.All patients were divided into 3 groups:low risk(score 2~3),intermediate risk(score 4),and high risk(score 5~10);MACE rates were 6.7%(1/15),21.1%(18/85)and 58.9%(222/377),respectively(P<0.001).Different triage recommen⁃dations were given:be discharged early,stay in the emergency department for further clinical evaluation,and be immedi⁃ately a

关 键 词：急性胸痛 动脉粥样硬化性心血管病 HEART风险评分 心脏不良事件 

分 类 号：R541[医药卫生—心血管疾病]