6种常见模型评分对NSTEMI患者远期预后预测价值的验证和比较  

Validation and comparison of 6 common model scores in predicting long-term prognosis in patients with NSTEMI

作　　者：吴纪昆 徐榕笛 许景涵 王乐 丛洪良[2] WU Jikun;XU Rongdi;XU Jinghan;WANG Le;CONG Hongliang(Clinical School of Thoracic,Tianjin Medical University,Tianjin 300222,China;the Eighth Department of Cardiology,Tianjin Chest Hospital)

机构地区：[1]天津医科大学胸科临床学院,300222 [2]天津市胸科医院心内八科

出　　处：《天津医药》2024年第5期541-547,共7页Tianjin Medical Journal

基　　金：天津市医学重点学科(专科)建设资助项目(TJYXZDXK-055B)。

摘　　要：目的验证和比较6种常用模型评分对非ST段抬高型心肌梗死(NSTEMI)患者远期主要不良心血管事件(MACE)的预测价值。方法收集1136例NSTEMI患者的临床资料。根据患者的GRACE评分、TIMI评分、ACEF评分、mACEF评分、CHA2DS2-VASc评分及CAMI-NSTEMI评分分为低、中、高危组。统计患者在随访期间MACE的发生情况。Kaplan-Meier法比较各评分风险分层患者的MACE发生率,受试者工作特征曲线和Hosmer-Lemeshow拟合优度检验来验证和比较6种模型评分对NSTEMI患者远期MACE的预测价值。结果本研究最终纳入909例NSTEMI患者,有225例患者发生了MACE。6种评分低、中、高危组间累积MACE发生率差异均有统计学意义,高危组累积MACE发生率均最高。CHA2DS2-VASc评分、ACEF评分及mACEF评分对NSTEMI患者远期发生MACE预测价值尚可[曲线下面积(AUC)分别为0.675、0.660、0.662],TIMI评分、CAMI-NSTEMI评分和GRACE评分的预测价值一般(AUC分别为0.596、0.618、0.640)。所有模型评分对患者远期发生MACE的预测具有很好的校准度。结论CHA2DS2-VASc评分和mACEF评分对患者远期预后的预测能力较好,可以作为NSTEMI患者远期预后的评分工具。Objective To validate and compare the predictive value of six commonly used model scores on long-term all-cause mortality and major adverse cardiovascular events(MACE)in patients with non-ST elevation myocardial infarction(NSTEMI).Methods The clinical data of 1136 NSTEMI patients were collected.According to the GRACE score,TIMI score,ACEF score,mACEF score,CHA2DS2-VASc score and CAMI-NSTEMI score,patients were divided into three groups:the low risk group,the medium risk group and the high risk group.The occurrence of MACE in patients during the follow-up period was counted.Kaplan-Meier method was used to compare the incidence of MACE in patients with various risk stratification scores,receiver operating characteristic(ROC)curve and Hosmer-Lemeshow goodness of fit test to verify and compare the predictive value of six model scores in predicting long-term MACE.Results A total of 909 patients with NSTEMII were included in this study,and 225 patients developed MACE.There were statistically significant differences in the cumulative MACE incidence rates between the six score groups of low,medium and high risk scores.The cumulative MACE incidence in the high-risk group was the highest.CHA2DS2-VASc score,ACEF score and mACEF score had acceptable predictive value for long-term MACE in patients with NSTEMI(AUC:0.675,0.660,0.662),while the predictive value of TIMI score,CAMI-NSTEMI score and GRACE score were average(AUC:0.596,0.618,0.640).All model scores showed good calibration for predicting long-term occurrence of MACE.Conclusion The CHA2DS2-VASc score and mACEF score have good predictive ability for the long-term prognosis of patients,and can be used as scoring tools for the long-term prognosis of NSTEMI patients.

关 键 词：非ST段抬高型心肌梗死 模型评分 远期预后 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]