老年急性冠脉综合征1年内主要不良心脑血管事件预测评分体系的构建及效能评估  

Construction and efficacy evaluation of a scoring system for predicting major adverse cardiovascular and cerebrovascular events within 1 year in elderly patients with acute coronary syndrome

作　　者：王国栋[1] 刘慧珍[2] 商娜 李俊玉 刘小蒙 郭树彬[3] Wang Guodong;Liu Huizhen;Shang Na;Li Junyu;Liu Xiaomeng;Guo Shubin(Cardiovascular Department,Beijing Bo'Ai Hospital,China Rehabilitation Research Center,Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Department of Emergency Medicine,Beijing Bo'Ai Hospital,China Rehabilitation Research Center,Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Emergency Medicine Clinical Research Center,Beijing Chao-Yang Hospital,Capital Medical University,Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing 100020,China)

机构地区：[1]首都医科大学康复医学院,中国康复研究中心北京博爱医院心血管内科,北京100068 [2]首都医科大学康复医学院,中国康复研究中心北京博爱医院急诊科,北京100068 [3]首都医科大学附属北京朝阳医院急诊医学临床研究中心,心肺脑复苏北京市重点实验室,北京100020

出　　处：《中华急诊医学杂志》2023年第7期881-888,共8页Chinese Journal of Emergency Medicine

基　　金：中国康复研究中心科研项目(2019ZX-24);心肺脑复苏北京市重点实验室开放课题(2020XFN-KFKT-01)。

摘　　要：目的建立老年急性冠脉综合征(acute coronary syndrome,ACS)患者1年内发生主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular event,MACCE)的预测评分体系,并评价其预测效能。方法采用前瞻性队列研究方法,连续入选2019年1月至2021年12月北京博爱医院经急诊收入心血管内科监护病房(cardiovascular care unit,CCU)或急诊监护病房(emergency intensive care unit,EICU)的老年ACS患者。收集患者一般资料;记录住院期间发生恶性心律失常、完全血运重建、急性肾损伤(acute kidney injury,AKI)情况;24 h内测定血肌酐(serum creatinine,Scr)、白蛋白(albumin,Alb)、超敏C-反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、肌酸激酶同工酶(creatinine kinase-MB,CK-MB)、D-二聚体(D-dimer)、心肌肌钙蛋白(I cardiac troponin I,cTnI)、N末端脑钠肽前体(NT-pro-BNP)等实验室指标;24 h内行经胸超声心动图检查;进行Killip分级、衰弱筛查问卷(frailty screening questionnaire,FSQ)评分;随访患者1年内发生MACCE的情况,采用单因素及多因素Logistic回归分析筛选MACCE的影响因素;绘制受试者工作特征(receiver operating characteristic,ROC)曲线确定连续型变量的截断值,参考临床进行离散化,根据各变量的β回归系数设立相应分值,建立MACCE的临床预测评分量表,采用ROC曲线评价其预测效能。结果共入选322例老年ACS患者,1年内MACCE的发生率为24.5%。单因素Logisitc回归分析初步筛选自变量后显示,MACCE的影响因素(P<0.2)包括:①连续型指标:年龄、体质量指数(body mass index,BMI)、Alb、hs-CRP、D-dimer、NT-pro-BNP、射血分数(ejection fraction,EF)、Killip分级、FSQ评分;②离散型指标:共患病≥3个、是否完全血运重建、合并AKI。对连续型指标离散化后进行多因素Logistic回归分析显示,年龄≥84岁、未完全血运重建、合并AKI、EF≤50%、FSQ≥3分是发生MACCE的独立危险因素[年龄≥84岁:优势比(OR)=4.Objective To establish a prediction model for major adverse cardiovascular and cerebrovascular events(MACCE)in elderly patients with emergency acute coronary syndrome(ACS)within 1 year,and to evaluate its prediction efficiency.Methods This was a prospective cohort study.Elderly ACS patients who were admitted to the Cardiovascular Care Unit(CCU)or the Emergency Intensive Care Unit(EICU)in Beijing Bo'Ai Hospital through emergency department from January 2019 to December 2021 were successively enrolled.General data of the patients were collected within 24 h after admission,the incidence of malignant arrhythmia,complete revascularization and acute kidney injury(AKI)during hospitalization were recorded.Within 24 h,laboratory indexes such as serum creatinine(Scr),albumin(Alb),hypersensitive C-reactive protein(hs-CRP),creatine kinase isoenzyme MB(CKMB),D-dimer,cardiac troponin I(cTnI)and N-terminal pro-brain natriuretic peptide(NT-pro-BNP)were measured.In addition,transthoracic echocardiography and the Frailty Screening Questionnaire(FSQ)were performed.Patients were followed up for the occurrence of MACCE within 1 year.The influencing factors of MACCE were screened by univariable and multivariable logistic regression analysis.The cutoff values of continuous variables were determined by receiver operating characteristic(ROC)curve and discretization was carried out with reference to clinical practice.Corresponding scores were set up according to the β regression coefficient of each variable to establish a clinical prediction score scale of MACCE.Finally,ROC curve was used to evaluate its prediction efficiency.Results The study enrolled 322 elderly ACS patients,and the incidence of MACCE within 1 year was 24.5%.After preliminary screening of independent variables by univariable logistic regression analysis,the influencing factors of MACCE(P<0.2)were as follows:①Continuous indicators:age,body mass index(BMI),Alb,hs-CRP,D-dimer,NT-pro-BNP,ejection fraction(EF),Killip grade and FSQ score;②Discrete indicators:≥3 comorbi

关 键 词：老年 急性冠脉综合征 主要不良心脑血管事件 预测评分体系 预测效能 

分 类 号：R541.4[医药卫生—心血管疾病]