GRACE、CADILLC及TIMI评分对STEMI患者PCI术后主要心脏不良事件的预测价值比较  

Comparison of GRACE, CADC, and TIMI scores to evaluate major cardiac adverse events after percutaneous coronary intervention in patients with ST segment elevation myocardial infarction

作　　者：吴益波 饶志高 张奇军 Wu Yibo;Rao Zhigao;Zhang Qijun(General Department,the Affiliated People's Hospital of Ningbo University,Ningbo 315100,Zhejiang Province,China)

机构地区：[1]宁波大学附属人民医院全科医学科,宁波315100

出　　处：《中国基层医药》2024年第5期747-752,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的比较全球急性冠状动脉事件注册(GRACE)评分、改良阿昔单抗与支架植入降低血管成形术后并发症的对照研究评分(改良CADILLAC评分)和心肌梗死溶栓治疗临床试验(TIMI评分)对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后主要心脏不良事件(MACEs)的预测价值。方法回顾性收集2018年1月至2022年1月宁波大学附属人民医院诊断STEMI患者80例为研究对象,患者均采用PCI治疗,术后常规随访1~15个月,中位时间7.5个月。记录MACEs,主要包括靶血管重建、再发心梗、新发心衰、恶性心律失常和心源性死亡。结果PCI术后80例中,18例患者发生MACEs(22.5%,18/80)。单因素分析发现,MACEs组患者年龄增大、多支血管病变增多、支架植入长度较长、肌钙蛋白I(cTnI)峰值和持续时间增加及总缺血时间>6 h等与无MACES组比较,差异均有统计学意义(均P<0.05);MACEs组术后7 d GRACE评分[(136.5±30.4)分]、改良CADILLAC评分[(11.2±3.4)分]和TIMI评分[(5.7±1.5)分]显著升高,GRACE评分-高危12/18(66.67%)、CADILLAC评分-高危13/18(72.22%)和TIMI评分-高危11/18(61.11%)患者占比显著增多,差异均有统计学意义(χ^(2)=23.22、21.35、24.42,均P<0.05)。年龄增大、总缺血时间>6 h,GRACE评分-高危、CADILLAC评分-高危和TIMI评分-高危均是STEMI患者PCI术后1年内发生MACEs的独立危险因素(HR值分别为1.079,2.037,3.562、3.421、3.236)。受试者工作特征曲线(ROC曲线)显示,GRACE评分-高危、CADILLAC评分-高危和TIMI评分-高危预测MACEs的曲线下面积(AUC)分别为0.816、0.823和0.803,三者差异无统计学意义(P>0.05)。结论GRACE、改良CADILLAC评分和TIMI评分对STEMI患者PCI术后MACEs均具有预测价值,且3种评分对预测1年内发生MACEs的风险均具有较好的准确性。Objective To compare the predictive values of the Global Registry of Acute Coronary Events(GRACE)risk scores,the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications(CADILLAC)trial scores,and the Thrombolysis In Myocardial Infarction(TIMI)scores for major adverse cardiac events(MACEs)in patients with acute ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention.Methods A retrospective analysis was conducted on 80 STEMI patients diagnosed at the Affiliated People's Hospital of Ningbo University from January 2018 to January 2022,all of whom received percutaneous coronary intervention.The patients were followed up for 1-15 months with a median time of 7.5 months.MACEs,mainly including target vessel reconstruction,recurrent myocardial infarction,new heart failure,malignant arrhythmia,and cardiac death,were recorded.Results Of the 80 patients,MACEs occurred in 18 cases(22.5%,18/80)after percutaneous coronary intervention.Univariate analysis found that patients in the MACEs group had an increase in age,multiple vessel lesions,stent implantation length,peak and duration of troponin I,and total ischemia time>6 hours,which were significantly different from those in the non-MACEs group(P<0.05).The MACEs group showed a significant increase in GRACE score[(136.5±30.4)scores],modified CADILLAC score[(11.2±3.4)score],and TIMI score[(5.7±1.5)scores]at 7 days after surgery.The percentage of patients with GRACE score high-risk[12/18(66.67%)],CADILLAC score high-risk[13/18(72.22%)],and TIMI score high-risk[11/18(61.11%)]increased significantly(χ^(2)=23.22,21.35,24.42,all P<0.05).Increasing age,total ischemia time>6 hours,GRACE score high-risk,CADILLAC score high-risk and TIMI score high-risk were all independent risk factors for MACEs at 1-year follow-up in STEMI patients(HR values were 1.079,2.037,3.562,3.421,and 3.236,respectively).The receiver operating characteristic curve showed that the area under the curve of GRACE score high-risk,CADILLAC score high-ris

关 键 词：ST段抬高型心肌梗死 经皮冠状动脉介入治疗 机械溶栓 心力衰竭 肌钙蛋白 

分 类 号：R542.22[医药卫生—心血管疾病]