不同危险评分系统对中老年急性冠脉综合征患者主要不良心血管事件发生的预测价值比较  

Comparisons on the long-term predictive values of different risk scoring systems for the major adverse cardiovascular events among the middle-elderly acute coronary syndrome patients

作　　者：秦巍 薛文平 祝丽丽 刘佳梅[1] 于海艳 吕新琳 冯超群 刘静怡[1] 卜海伟 田雅楠[1] QIN Wei;XUE Wenping;ZHU Lili;LIU Jiamei;YU Haiyan;LV Xinlin;FENG Chaoqun;LIU Jingyi;BU Haiwei;TIAN Yanan(Department of Cardiology,The Affiliated Hospital of Chengde Medical College,Chengde,067000,China)

机构地区：[1]承德医学院附属医院心脏内科,河北承德067000

出　　处：《中华高血压杂志（中英文）》2024年第4期354-362,共9页Chinese Journal of Hypertension

基　　金：河北省医学科学研究课题(20210861);2021年承德市科学技术研究与发展计划项目(202109A036)。

摘　　要：目的 比较心肌梗死溶栓治疗临床试验(TIMI)、全球急性冠状动脉事件注册表(GRACE)和韩国急性心肌梗死注册表(KAMIR)危险评分对不同类型中老年急性冠脉综合征(ACS)患者出院1年内主要不良心血管事件(MACE)的预测价值。方法 回顾性收集2020年1月至2022年4月在承德医学院附属医院心脏内科就诊的中老年ACS患者415例,查阅其完整病历资料,根据临床诊断分为急性ST段抬高型心肌梗死(STEMI)、急性非ST段抬高型心肌梗死(NSTEMI)及不稳定性心绞痛(UAP)三组,计算其入院时TIMI、GRACE及KAMIR危险评分,记录出院1年内MACE发生情况。分析STEMI、NSTEMI及UAP组中TIMI、GRACE及KAMIR危险评分与MACE的相关性,绘制不同评分系统预测不同类型ACS患者发生MACE的受试者工作特征曲线(ROC曲线),计算并比较曲线下面积(AUC)。结果 415例中老年ACS患者中包括STEMI、NSTEMI及UAP各113例、70例及232例,其出院1年内MACE发生率分别为30.09%,31.43%及32.76%。Spearman相关分析发现,STEMI、NSTEMI及UAP三组中TIMI(r=0.644,0.665,0.578,均P<0.001)、GRACE(r=0.718,0.798,0.719,均P<0.001)及KAMIR(r=0.579,0.623,0.582,均P<0.001)危险评分均与MACE评分呈正相关。ROC曲线显示,STEMI及NSTEMI患者GRACE危险评分AUC明显高于TIMI及KAMIR危险评分[AUC(95%CI):STEMI,0.835(0.809~0.861)比0.764(0.741~0.787)、0.731(0.686~0.776);NSTEMI,0.848(0.797~0.899)比0.725(0.703~0.748)、0.713(0.670~0.759);均P<0.05];UAP患者中GRACE危险评分AUC高于TIMI危险评分[AUC(95%CI):0.783(0.726~0.841)比0.711(0.667~0.755),P<0.05],但与KAMIR危险评分差异无统计学意义[0.783(0.726~0.841)比0.736(0.696~0.776),P>0.05];三组中TIMI及KAMIR危险评分AUC差异无统计学意义(均P>0.05)。结论 TIMI、GRACE及KAMIR危险评分均与中老年ACS患者后续治疗过程中一年内发生MACE有关,可作为随访中制定治疗方案的参考。但考虑到实际可操作性,STEMI及NSTEMI优先使用GRACE危险评分系统,而UAP优先使用KAMObjective To compare the predictive values of thrombolysis in myocardial infarction(TIMI), global registration of acute coronary events(GRACE) and Korean registry for acute myocardial infarction risk(KAMIR) scores on the occurrences of major adverse cardiovascular events(MACE) within one year after the hospitalization among the patients with different types of middle-elderly acute coronary syndrome(ACS). Methods Clinical data of 415 middle-elderly subjects were obtained in the department of Cardiology from the Affiliated Hospital of Chengde Medical College from January 2020 to April 2022. According to their clinical diagnosis, they were subsumed into three different subgroups, such as ST segment elevation myocardial infarction(STEMI), non-ST segment elevation myocardial infarction(NSTEMI) and unstable angina pectoris(UAP). Their TIMI, GRACE, and KAMIR risk scores at the admission were calculated. Then their incidences of MACE were recorded within one year of follow-up. The correlations between the risk scores(TIMI, GRACE, and KAMIR) and occurrences of MACE among the STEMI, NSTEMI and UAP subgroups were analyzed. Meanwhile, the area under the receiver operating characteristic(ROC) curve(AUC) was used to evaluate the predictive values of TIMI, GRACE, and KAMIR on the accuracy of MACE. Results Among the 415 middle-elderly ACS subjects, 113 were STEMI, 70 were NSTEMI, and 232 were UAP. Their incidences of MACE were respectively 30.09%, 31.43%, and 32.76%within one year of follow-up. Moreover, it was found that there were positive correlations between the TIMI(r=0.644, 0.665, 0.578,P<0.001), GRACE(r=0.718, 0.798, 0.719, P<0.001) and KAMIR risk scores(r=0.579, 0.623, 0.582, P<0.001) with MACE score through Spearman correlation analysis among the STEMI, NSTEMI and UAP groups respectively(P<0.05). The ROC curve showed that the AUC of GRACE risk score was significantly higher than that of TIMI and KAMIR risk scores among both the STEMI and NSTEMI patients [AUC(95%CI): STEMI, 0.835(0.809-0.861) vs 0.764(0.741-0.787), 0.731

关 键 词：急性冠脉综合征 心肌梗死溶栓治疗临床试验 全球急性冠状动脉事件注册表 韩国急性心肌梗死注册表 危险评分 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]