CHA_(2)DS_(2)-VASc评分联合D-二聚体/纤维蛋白原比值对急性ST段抬高型心肌梗死相关动脉自发再通的预测价值  

Prediction value of CHA_(2)DS_(2)-VASc score combined with D-dimer/fibrinogen ratio for spontaneous recanalization of acute ST-segment elevation myocardial infarction infarct-associated arteries

作　　者：朱仁欢 刘凯 ZHU Ren-huan;LIU Kai(Department of Cardiology,Anqing Municipal Hospital,Anqing 246000,China)

机构地区：[1]安庆市立医院心内科,安徽省安庆市246000

出　　处：《中国心血管病研究》2024年第2期141-146,共6页Chinese Journal of Cardiovascular Research

基　　金：安徽省卫生厅医药科研计划项目(12925KJ20210331)。

摘　　要：目的探讨CHA_(2)DS_(2)-VASc评分联合D-二聚体(D-D)/纤维蛋白原(FIB)比值(DFR)对急性ST段抬高型心肌梗死(ASTEMI)梗死相关动脉自发再通(IRA-SR)的预测价值。方法选取安庆市立医院2021年9月至2023年1月ASTEMI患者108例,入院后均行急诊冠状动脉造影及心肌梗死溶栓治疗试验(TIMI),将TIMI 2~3级纳入SR组(35例),TIMI 0~1级纳入非SR组(73例)。比较两组CHA_(2)DS_(2)-VASc评分、DFR水平、不同CHA_(2)DS_(2)-VASc评分患者DFR水平,分析CHA_(2)DS_(2)-VASc评分与DFR相关性及两者对ASTEMI患者IRA-SR的预测价值。结果两组CHA_(2)DS_(2)-VASc评分等级存在显著差异(P<0.05);SR组CHA_(2)DS_(2)-VASc评分、D-D、FIB、DFR水平低于非SR组(P<0.05);SR组、非SR组CHA_(2)DS_(2)-VASc评分1~2分患者D-D、FIB、DFR水平<3~4分患者<4分以上患者(P<0.05);SR组、非SR组CHA_(2)DS_(2)-VASc评分与DFR均呈正相关(r=0.600、0.790,P均<0.001);CHA_(2)DS_(2)-VASc评分、DFR预测ASTEMI患者IRA-SR的AUC为0.832(95%CI0.748~0.897)、0.816(95%CI 0.730~0.884);根据2.4 ROC曲线分析中所获取最佳截断值分为高水平与低水平,CHA_(2)DS_(2)-VASc评分、DFR低水平的ASTEMI患者梗死相关动脉SR可能性高于高水平患者(P<0.05);CHA_(2)DS_(2)-VASc评分联合DFR预测ASTEMI患者IRA-SR的AUC为0.907(95%CI 0.836~0.955),敏感度为71.43%,特异度为95.89%,优于二者单独预测。结论CHA_(2)DS_(2)-VASc评分联合DFR预测ASTEMI患者IRA-SR的价值较为可靠,能为临床制定治疗方案提供指导信息。Objective To investigate the predictive value of CHA_(2)DS_(2)-VASc score combined with D-dimer(D-D)/fibrinogen(FIB)ratio(DFR)in infarct-associated spontaneous revascularization(IRA-SR)in acute ST segment elevation myocardial infarction(ASTEMI).Methods A total of 108 patients with ASTEMI from September 2021 to January 2023 were selected,all of whom underwent emergency coronary angiography and thromolytic therapy test for myocardial infarction(TIMI)after admission.TIMI grade 2 to 3 was included in the SR group(35 cases),and TIMI grade 0 to 1 was included in the non-SR group(73 cases).CHA_(2)DS_(2)-VASc score,DFR level and DFR level of patients with different CHA_(2)DS_(2)-VASc score were compared between the two groups,and the correlation between CHA_(2)DS_(2)-VASc score and DFR level and the predictive value of both on IRA-SR in ASTEMI patients were analyzed.Results There were significant differences in CHA_(2)DS_(2)-VASc scores between the two groups(P<0.05).The CHA_(2)DS_(2)-VASc score,D-D,FIB and DFR levels in SR group were lower than those in non-SR group(P<0.05).Patients with 1-2 CHA_(2)DS_(2)-VASc score in the SR group and non-SR group had D-D,FIB and DFR levels<3-4 points and above 4 points(P<0.05).The CHA_(2)DS_(2)-VASc score in both 2 groups was positively correlated with DFR(r=0.600,0.790,P<0.001).The AUC of IRA-SR predicted by CHA_(2)DS_(2)-VASc score and DFR were 0.832(95%CI 0.748-0.897)and 0.816(95%CI 0.730-0.884).According to the optimal cut-off value obtained in 2.4 ROC curve analysis,ASTEMI patients with CHA_(2)DS_(2)-VASc score and DFR level were divided into the higher and lower levels,and the likelihood of infarct-related artery SR of patients with the lower level was higher than that of patients with the higher level(P<0.05).CHA_(2)DS_(2)-VASc score combined with DFR predicted that the AUC of IRA-SR in ASTEMI patients was 0.907(95%CI 0.836-0.955),with the sensitivity of 71.43% and the specificity of 95.89%,which was better than the two predictions alone.Conclusion CHA_(2)DS_(2)-VASc score comb

关 键 词：急性ST段抬高型心肌梗死 梗死相关动脉 自发再通 CHA_(2)DS_(2)-VASc评分 D-二聚体/纤维蛋白原比值 预测价值 

分 类 号：R542.22[医药卫生—心血管疾病]