心肌梗死溶栓危险指数与GRACE评分的相关性及其与NSTEMI患者远期预后的关系  

Relationships between thrombolysis risk index in myocardial infarction and GRACE score in patients with non-ST segment elevation acute myocardial infarction and their long-term outcome

作　　者：张莹莹[1] 郭绪昆[1] 郑君毅[1] 刘寅[1] Zhang Yingying;Guo Xukun;Zheng Junyi;Liu Yin(Department of Cardiology,Tianjin Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津市胸科医院心内科,天津300222

出　　处：《中国中西医结合急救杂志》2021年第5期541-545,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：天津市科技计划项目(16ZXMJSY00150);天津市胸科医院院级基金项目(2018XKZ01)。

摘　　要：目的探讨心肌梗死溶栓危险指数(TRI)与非ST段抬高型心肌梗死(NSTEMI)患者全球急性冠状动脉事件注册风险评分(GRACE)的相关性及其与患者远期预后的关系。方法采用前瞻性研究方法,连续纳入2016年12月至2017年6月在天津市胸科医院接受经皮冠状动脉介入治疗(PCI)的634例NSTEMI患者。根据受试者工作特征曲线(ROC)分析TRI预测NSTEMI患者行PCI术后2年发生主要不良心血管事件(MACE)的最佳截断值,将患者分为高TRI组(294例)和低TRI组(340例)。采用多因素Logistic回归分析TRI与GRACE评分≥141分的相关性,采用Cox比例风险回归模型分析NSTEMI患者行PCI术后2年发生MACE的影响因素。结果高TRI组患者的GRACE评分明显高于低TRI组(分:113.14±15.14比87.43±14.96,P<0.01)。多因素Logistic回归分析显示,TRI与GRACE评分≥141分独立相关〔优势比(OR)=1.223,95%可信区间(95%CI)为1.142~1.309,P<0.01〕。随访至术后2年,高TRI组MACE发生率明显高于低TRI组〔20.1%(59/294)比7.1%(24/340),P<0.01〕。多因素Cox回归分析显示,TRI〔风险比(HR)=1.081,95%CI为1.025~1.140,P<0.01〕、GRACE评分(HR=1.034,95%CI为1.018~1.051,P<0.01)、冠状动脉病变程度评分(SYNTAX,HR=1.044,95%CI为1.017~1.073,P<0.01)、合并糖尿病(HR=1.695,95%CI为1.014~2.834,P<0.05)、中性粒细胞比例(NEU%,HR=1.090,95%CI为1.003~1.184,P<0.05)均是NSTEMI患者行PCI术后2年发生MACE的独立危险因素。TRI预测NSTEMI患者行PCI术后2年发生MACE的ROC曲线下面积(AUC)为0.691(95%CI为0.631~0.752,P<0.01),当TRI最佳截断值为19.35时,敏感度为71.1%,特异度为57.5%。结论TRI与GRACE评分≥141分独立相关,高TRI是NSTEMI患者行PCI术后2年发生MACE的独立危险因素。Objective To investigate the relationships between myocardial infarction thrombolysis risk index(TRI)and risk scores of global registry of acute coronary artery events(GRACE)in patients with non-ST segment elevation acute myocardial infarction(NSTEMI)and their long term outcomes.Methods A prospective study was conducted,including 634 consecutive NSTEMI patients undergoing percutaneous coronary intervention(PCI)from December 2016 to June 2017 in Tianjin Chest Hospital.The receiver operating characteristic(ROC)curve was used to analyze the optimal cut-off value(19.35)of TRI for predicting the occurrence of major adverse cardiovascular events(MACE)in NSTEMI patients 2 years after PCI,and the patients were divided into a high TRI group(294 cases)and a low TRI group(340 cases).Multivariate logistic regression analyses were used for determining the relationship between TRI and GRACE score≥141,Cox regression analyses were used to identify the influence factors of occurring MACE 2 years after PCI in NSTEMI patients.Results The GRACE score was higher in high TRI group than that in low TRI group(score:113.14±15.14 vs.87.43±14.96,P<0.01).According to multivariate logistic regression analyses,TRI was independently associated with GRACE score≥141(OR=1.223,95%CI was 1.142-1.309,P<0.01).In 2 years follow-up,the incidence of MACE was significantly higher in high TRI group than that in low TRI group[20.1%(59/294)vs.7.1%(24/340),P<0.01].Multivariate Cox regression analysis showed that TRI[hazard retio(HR)=1.081,95%CI was 1.025-1.140,P<0.01],GRACE score(HR=1.034,95%CI was 1.018-1.051,P<0.01),and SYNTAX score(HR=1.044,95%CI was 1.017-1.073,P<0.01),combined with diabetes mellitus(HR=1.695,95%CI was 1.014-2.834,P<0.05)and the elevated percentage of neutrophils(HR=1.090,95%CI was 1.003-1.184,P<0.05)were the independent risk factors for the occurrence of MACE in NSTEMI patients after PCI during 2 years of follow-up.The area under ROC curve(AUC)of TRI on predicting MACE occurrence in NSTEMI patients after PCI for 2 years was 0.691(

关 键 词：冠状动脉粥样硬化性心脏病 急性冠脉综合征 心肌梗死溶栓危险指数 全球急性冠状动脉事件注册风险评分 

分 类 号：R54[医药卫生—心血管疾病]