CHA2DS2-VASc评分对冠状动脉CTO患者PCI预后的预测价值  

The value of CHA2DS2-VASc score for predicting percutaneous coronary intervention prognosis in patients with coronary chronic total occlusion

作　　者：张晶晶[1] 朱华良 丁旵东[1] 祝小霞[1] Zhang Jingjing;Zhu Hualiang;Ding Chandong;Zhu Xiaoxia(Department of Geriatric Cardiovascular Medicine,The Second Hospital of Anhui Medical University,Hefei 230011,Anhui Province,China)

机构地区：[1]安徽医科大学第二附属医院老年心血管内科,合肥230011

出　　处：《中国基层医药》2023年第5期730-734,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨CHA2DS2-VASc评分对冠状动脉慢性完全闭塞(CTO)患者经皮冠状动脉介入治疗(PCI)术后中远期预后的预测价值。方法回顾性分析安徽医科大学第二附属医院2019年1月至2020年12月行PCI的冠状动脉CTO患者139例的临床资料,根据患者的预后情况,分为预后良好组和预后不良组。应用单因素和多因素Cox回归分析评估CTO患者PCI术后不良事件的影响因素,绘制受试者工作特征曲线(ROC曲线)评估CHA2DS2-VASc评分对冠状动脉CTO患者PCI术后不良事件发生的预测价值。结果139例冠状动脉CTO患者中,在(19.88±7.90)个月的随访期内,有19例(13.7%)预后不良,120例(86.3%)预后良好。预后不良组年龄、尿酸、CHA2DS2-VASc评分分别为73(65.0,77.0)岁、(383.26±120.60)μmol/L、4(3,5)分,均高于预后良好组的66(57.0,71.8)岁、(322.68±91.88)μmol/L、3(2,4)分(U=-2.74、t=2.24、U=-3.09,均P<0.05)。但预后不良组CTO血管成功开通比例、白蛋白、血红蛋白、三酰甘油分别为11例(57.9%)、36.7(34.4,38.3)g/L、(120.26±19.74)g/L、1.03(0.85,1.49)mmol/L,均低于预后良好组的98例(81.7%)(χ^(2)=4.16,P=0.041)、39.3(36.78,42.1)g/L(U=-2.85,P=0.004)、(133.62±16.84)g/L(t=1.52,P=0.002)、1.52(1.09,2.25)mmol/L(U=-2.13,P=0.033)。多因素Cox回归分析显示,CHA2DS2-VASc评分是冠状动脉CTO行PCI术患者预后不良的危险因素(95%CI:1.137~2.274,P=0.007)。ROC曲线分析结果显示CHA2DS2-VASc评分预测冠状动脉CTO行PCI术患者预后不良的曲线下面积为0.716(95%CI:0.588~0.844,P=0.003),预测临界值为3.5,预测临界值对应的敏感性为68.4%、特异性为66.7%。结论与预后良好者相比,预后不良者的CHA2DS2-VASc评分明显增高,CHA2DS2-VASc评分对冠状动脉CTO患者PCI术后中远期预后具有一定应用价值。Objective To investigate the value of CHA2DS2-VASc score for predicting percutaneous coronary intervention(PCI)prognosis in patients with coronary chronic total occlusion.Methods The clinical data of 139 patients with coronary chronic total occlusion who underwent PCI at the Second Hospital of Anhui Medical University from January 2019 to December 2020 were retrospectively analyzed.These patients were divided into good prognosis and poor prognosis groups according to prognosis outcomes.Univariate and multivariate Cox regression analysis was performed to evaluate the influential factors of adverse events after PCI in patients with coronary chronic total occlusion.The receiver operating characteristic curves were plotted to evaluate the value of the CHA2DS2-VASc score for predicting the occurrence of adverse events in patients with coronary chronic total occlusion undergoing PCI.Results Among the 139 patients with coronary chronic total occlusion,the average follow-up time was(19.88±7.90)months,19(13.7%)patients had a poor prognosis,and 120(86.3%)patients had a good prognosis.The age,uric acid,and CHA2DS2-VASc score in the poor prognosis group were 73(65.0,77.0)years,(383.26±120.60)μmol/L,and 4(3,5)points,respectively,which were significantly higher than 66(57.0,71.8)years,(322.68±91.88)μmol/L,and 3(2,4)points in the good prognosis group(U=-2.74,t=2.24,U=-3.09,all P<0.05).However,the proportion of patients with the successful opening of the occluded coronary artery and albumin,hemoglobin,and triacylglycerol levels in the poor prognosis group were 11(57.9%),36.7(34.4,38.3)g/L,(120.26±19.74)g/L,and 1.03(0.85,1.49)mmol/L,respectively,which were significantly lower than 98(81.7%)(χ^(2)=4.16,P=0.041),39.3(36.78,42.1)g/L(U=-2.85,P=0.004),(133.62±16.84)g/L(t=1.52,P=0.002),and 1.52(1.09,2.25)mmol/L(U=-2.13,P=0.033)in the good prognosis group.Multivariate Cox regression analysis showed that CHA2DS2-VASc score was a risk factor for poor prognosis of patients with coronary chronic total occlusion undergoing PCI(95%CI:

关 键 词：冠状动脉疾病 冠状动脉闭塞 经皮冠状动脉介入治疗 血管造影术 CHA2DS2-VASc评分 ROC曲线 

分 类 号：R541.4[医药卫生—心血管疾病]