三种评分对急性STEMI患者PCI术后短期死亡风险的预测价值分析  

Predictive Value of 3 Scores for Short-Term Mortality Risk After PCI in Acute STEMI Patients

作　　者：江朋 唐勇[1] 郑庆昆[1] Jiang Peng;Tang Yong;Zheng Qingkun(Emergency Department,Second People's Hospital of Chengdu,Chengdu,Sichuan 610041,China)

机构地区：[1]成都市第二人民医院急诊科,四川成都610041

出　　处：《四川医学》2022年第6期529-535,共7页Sichuan Medical Journal

基　　金：成都市科技局支撑项目(编号:2015-HM01-00622-SF);成都市卫健委课题支撑项目(编号:2020209)。

摘　　要：目的比较三种评分对接受PCI治疗的STEMI患者院内死亡率、6个月死亡率的预估效能,帮助临床医生优化医疗决策。方法收集STEMI患者基本资料,入院时生命体征、首次实验室资料以及CAMI-STEMI评分、GRACE评分和TIMI评分。统计患者院内死亡率、PCI术后6个月死亡率。运用Logistic分析影响患者院内死亡、PCI术后6个月死亡的独立危险因素,并用ROC比较三种评分对患者院内死亡率和PCI术后6个月死亡率的预测效力。结果本研究共纳入362例STEMI患者。单因素、多因素Logistic回归分析结果显示:入院时心率、首次WBC计数、GRACE评分是影响患者院内死亡的独立危险因素(P<0.05)。高血压史、入院时心率、GRACE评分是患者PCI术后6个月死亡的独立危险因素(P<0.05)。GRACE评分、CAMI-STEMI评分、TIMI评分预估患者院内死亡率的AUC分别为0.827、0.789、0.735,GRACE评分预估效力优于TIMI评分,(P=0.028,95%CI 0.010~0.174)。GRACE评分、CAMI-STEMI评分、TIMI评分预估患者PCI术后6个月死亡率的AUC分别为0.855、0.782、0.744,GRACE评分评估效力优于CAMI-STEMI评分(P=0.007,95%CI 0.020~0.125)和TIMI评分(P=0.001,95%CI 0.043~0.178)。结论GRACE评分对接受PCI治疗的STEMI患者院内死亡率、6个月死亡率预估效力优于CAMI-STEMI评分和TIMI评分。CAMI-STEMI评分和TIMI评分对患者院内死亡率、6个月死亡率预估效力相当。Objective To compare predictive efficacy of 3 scores for in-hospital and 6-month mortality of STEMI patients receiving PCI,and help clinicians optimize medical decisions.Methods Basic data,vital signs,laboratory data,CAMI-STEMI score,GRACE score and TIMI score of STEMI on admission were collected.Mortality rate of in hospital and 6 months after PCI were calculated.Logistic analysis was used to analyze independent risk factors of in-hospital death and 6-month post-PCI death.ROC was used to compare predictive power of 3 scores for in-hospital mortality and 6-month mortality after PCI.Results 362 STEMI patients were included.Univariate and multivariate logistic regression analysis showed that heart rate at admission,first WBC count and GRACE score after admission were independent risk factors for in-hospital death(P<0.05).Hypertension history,heart rate at admission,and GRACE score were independent risk factors for death at 6 months after PCI(P<0.05).GRACE score,CAMI-STEMI score,and TIMI score predicted that AUC of in-hospital mortality of patients were 0.827,0.789,0.735,GRACE score was more effective than TIMI score(P=0.028,95%CI 0.010~0.174).GRACE score,CAMI-STEMI score,and TIMI score predicted that AUC of patient's 6-month mortality after PCI was 0.855,0.782,and 0.744.Evaluation effect of GRACE score was better than CAMI-STEMI score(P=0.007,95%CI 0.020~0.125)and TIMI score(P=0.001,95%CI 0.043~0.178).Conclusion GRACE score would be better than CAMI-STEMI score and TIMI score in predicting in-hospital and 6-month mortality of STEMI patients receiving PCI.CAMI-STEMI score and TIMI score could be equivalent in predicting in-hospital mortality and 6-month mortality of patients.

关 键 词：CAMI-STEMI评分 GRACE评分 TIMI评分 ST段抬高型心肌梗死 预后 

分 类 号：R541.4[医药卫生—心血管疾病]