CHA_(2)DS_(2)-VASc评分对急性心肌梗死患者院内结局事件的预测价值——China PEACE回顾性急性心肌梗死研究  

The predictive value of the CHA_(2)DS_(2)-VASc score for in-hospital outcomes in patients with acute myocardial infarction: China PEACE-retrospective acute myocardial infarction study

作　　者：卿平[1] 杨艳敏[2] 胡爽 于丽天[1] 徐唯 王璐璐[2] 索妮 Qing Ping;Yang Yanmin;Hu Shuang;Yu Litian;Xu Wei;Wang Lulu;Suo Ni(ICU,National Center for Cardiovascular Diseases,Fuwai Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037,China;Emergency Center,National Center for Cardiovascular Diseases,Fuwai Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037,China;National Clinical Research Center of Cardiovascular Diseases,State Key Laboratory of Cardiovascular Disease,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,阜外医院心内重症监护病房,北京100037 [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急诊中心,北京100037 [3]国家心血管病临床研究中心,心血管疾病国家重点实验室,北京100037

出　　处：《中华内科杂志》2022年第2期177-184,共8页Chinese Journal of Internal Medicine

基　　金：国家重点研发计划(2017YFC0908800)。

摘　　要：目的评估CHA_(2)DS_(2)-VASc评分对急性心肌梗死(AMI)患者院内结局事件的预测价值。方法回顾性分析冠心病医疗结果评价和临床转化研究(China PEACE)回顾性急性心肌梗死研究中23728例AMI患者的病历信息,按CHA_(2)DS_(2)-VASc评分分为低(0~3分)、中(4~6分)、高(7~9分)分值组。院内结局包括主要不良心血管事件、死亡、死亡或放弃治疗、再发心肌梗死、缺血性卒中等。采用多因素Cox回归分析CHA_(2)DS_(2)-VASc评分对AMI患者院内结局的影响。通过受试者工作特征(ROC)曲线,评估CHA_(2)DS_(2)-VASc评分对AMI患者院内死亡与死亡或放弃治疗的预测价值。结果入组患者年龄66(56,75岁)岁,女性占30.7%。CHA_(2)DS_(2)-VASc评分高分值组患者院内结局事件发生率更高,基础疾病更多(P值均<0.001);多因素logistic回归中,院内病死率(OR=6.13,95%CI 4.77~7.87,P<0.001)、院内死亡或放弃治疗率(OR=6.43,95%CI 5.16~8.00,P<0.001)、主要心血管事件发生率(OR=4.94,95%CI 4.06~6.01,P<0.001)明显高于其他两组。ROC曲线分析显示,无论院内病死率,还是死亡或放弃治疗率,CHA_(2)DS_(2)-VASc评分与简化版全球急性冠状动脉事件登记(global registry of acute coronary events,mini-GRACE)评分相比差异无统计学意义(ROC曲线下面积:0.699与0.696,P=0.752;0.708与0.713,P=0.489)。结论CHA_(2)DS_(2)-VASc评分是一种有效预测AMI患者院内风险的评估工具,该评分操作简单,预测价值与mini-GRACE评分相当。Objectives This study aimed to evaluate the predictive value of the CHA_(2)DS_(2)-VASc score for in-hospital outcomes of patients with acute myocardial infarction(AMI).Methods Data of 23728 patients from the China patient-centered Evaluative Assessment of cardiac Events(China PEACE)Retrospective Acute Myocardial Infarction Study were analyzed retrospectively.The patients were categorized into 3 groups according to the CHA_(2)DS_(2)-VASc scores:the low score group(score 1-3),the middle score group(score 4-6)and the high score group(score 7-9).The in-hospital outcomes included major adverse cardiovascular events(MACE),death,death or withdrawal from treatment,reinfarction,ischemic stroke,etc.The CHA_(2)DS_(2)-VASc score was incorporated into multivariate Cox regression analyses to determine its independent impact on in-hospital outcomes.Receiver operating Characteristic(ROC)curves were constructed,and the area under the curve(AUC)was used to evaluate the predictive value of the CHA_(2)DS_(2)-VASc score for in-hospital mortality and death or withdrawal from treatment,respectively.Results The patients had a median age of 66(56,75)years,and 30.7%of them were females.Patients with higher CHA_(2)DS_(2)-VASc scores had a higher in-hospital mortality and more in-hospital complications(all P<0.001).After adjustment of baseline covariates,the subjects in the high score group were associated with high risks of in-hospital mortality(OR=6.13,95%CI 4.77-7.87,P<0.001),death or treatment withdrawal(OR=6.43,95%CI 5.16-8.00,P<0.001)and MACE(OR=4.94,95%CI 4.06-6.01,P<0.001).The AUCs of the CHA_(2)DS_(2)-VASc score were comparable with those of the mini-global registry of acute coronary events(mini-GRACE)score in evaluation of in-hospital mortality(0.699 vs.0.696,P=0.752)and the death or treatment withdrawal risk(0.708 vs.0.713,P=0.489).Conclusions The CHA_(2)DS_(2)-VASc score is an independent predictor of in-hospital outcomes for patients with AMI.Its predictive value was comparable with the mini-GRACE score,which could be used as a

关 键 词：心肌梗死 医院死亡率 CHA_(2)DS_(2)-VASc评分 死亡或放弃治疗率 风险评估 

分 类 号：R542.22[医药卫生—心血管疾病]