急性STEMI患者90 d不良事件发生风险与心房颤动血栓危险度评分的关系研究  

Relationship between adverse event risk in 90d and atrial fibrillation thrombus risk score of patients with acute STEMI

作　　者：颜治 陈洋 王艳[1] 詹洮 冯大超 Yan Zhi;Chen Yang;Wang Yan;Zhan Tao;Feng Dachao(Department of Cardiology,Second People's Hospital of Yibin City,644000,China;不详)

机构地区：[1]宜宾市第二人民医院心内科,宜宾644000

出　　处：《中国循证心血管医学杂志》2023年第8期974-978,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 探讨急性ST段抬高型心肌梗死(STEMI)患者90 d不良事件发生风险与心房颤动(房颤)血栓危险度(CHA_(2)DS_(2)-VASc)评分的关系。方法 回顾性纳入2011年1月至2021年6月于宜宾市第二人民医院心内科接受治疗的急性STEMI患者748例,根据CHA_(2)DS_(2)-VASc评分分为三组:1分组(n=182)、2~3分组(n=359)、4分及以上组(n=207)。分析各组一般资料、治疗相关资料及90 d不良事件发生情况;采用Cox回归模型评价CHA_(2)DS_(2)-VASc评分对急性STEMI患者90 d不良事件发生风险的影响,描绘ROC曲线计算CHA_(2)DS_(2)-VASc评分用于患者90 d全因死亡预测临床效能。结果 三组年龄、性别、体重、发病至入院治疗时间、基线收缩压(SBP)、基线脉搏、Killip分级、心肌梗死部位、基线血糖相关指标、基线血红蛋白、既往疾病发生情况、经皮冠状动脉介入治疗(PCI)比例、ACEI/ARB药物使用比例、β受体阻滞剂使用比例及利尿剂使用比例比较差异均有统计学意义(P<0.05);三组全因死亡率、再发心肌梗死率、心源性休克发生率及卒中发生率比较差异亦均有统计学意义(P<0.05)。Cox回归模型单因素分析结果显示,CHA_(2)DS_(2)-VASc评分与急性STEMI患者90 d不良事件发生有关(P<0.05)。纳入CHA_(2)DS_(2)-VASc+心肌梗死溶栓治疗(TIMI)评分和CHA_(2)DS_(2)-VASc+全球急性冠脉事件注册(GRACE)评分构建模型多因素分析结果显示,CHA_(2)DS_(2)-VASc评分2~3分是除心源性休克外其他90 d不良事件独立危险因素(P<0.05);CHA_(2)DS_(2)-VASc评分4分及以上是全部90 d不良事件独立危险因素(P<0.05)。ROC曲线分析结果显示,CHA_(2)DS_(2)-VASc评分、TIMI评分及GRACE评分用于预测急性STEMI患者90 d全因死亡AUC分别为0.78(95%CI:0.71~0.83),0.79(95%CI:0.73~0.84),0.79(95%CI:0.74~0.85),差异无统计学意义(Z=0.87,P=0.51)。结论 CHA_(2)DS_(2)-VASc评分可独立用于急性STEMI患者90 d不良事件发生风险预测,其在全因死亡风险Objective To investigate the relationship between adverse event risk in 90 d and atrial fibrillation thrombus risk score of patients with acute STEMI.Methods Seven hundred forty-eight patients with acute STEMI were chosen from January 2011 to June 2021.All patients were grouped according to the CHA_(2)DS_(2)-VASc score,including 1 point group(182 cases),2~3 points groups(359 Cases),and 4 points and above groups(207 cases).The general data,treatment-related data,and 90dadverse events were analyzed.The Cox regression model was used to evaluate the influence of the CHA_(2)DS_(2)-VASc score on the risk of 90 d adverse events in patients with acute STEMI.ROC curve was drawn to calculate the CHA_(2)DS_(2)-VASc score and to predict the clinical efficacy of 90 d all-cause death.Results There was a significant difference in the age,sex,weight,time from onset to admission,baseline SBP,baseline pulse,Killip grade,location of myocardial infarction,baseline blood glucose related indicators,baseline hemoglobin,previous disease occurrence,the proportion of PCI treatment,the proportion of ACEI/ARB drugs,β receptor blockers and diuretics among three groups(P<0.05).There were significant differences in the incidence of all-cause mortality,recurrent myocardial infarction,cardiogenic shock,and stroke among the three groups(P<0.05).The univariate analysis of the Cox regression model showed that the CHA_(2)DS_(2)-VASc score was related to 90d adverse events in patients with acute STEMI(P<0.05).The model was constructed with CHA_(2)DS_(2)-VASc + thrombolytic therapy for myocardial infarction(TIMI) score and CHA_(2)DS_(2)-VASc + global register of acute coronary events(GRACE) score.The result of multivariate analysis showed that 2~3 points of CHA_2DS_(2)-VASc score was the independent risk factor for 90 d adverse events except for cardiogenic shock(P<0.05),and 4 points of CHA_(2)DS_(2)-VASc score or above was the independent risk factor for all 90 d adverse events(P<0.05).The ROC curve analysis showed that the AUCs of CHA_(2)DS_(2)-VAS

关 键 词：ST段抬高型心肌梗死 不良事件 心房颤动 血栓 全因死亡 

分 类 号：R542.22[医药卫生—心血管疾病]