急性冠脉综合征住院风险评分及其对血运重建的评价

目的 建立中国急性冠脉综合征(ACS)患者住院不良事件的风险评分,评价血运重建对不同风险人群的疗效.方法 收集1501例中国(全球性急性冠脉事件注册研究,GRACE)研究人选患者的基线特征、诊断治疗和住院转归,通过多因素Logistic回归方法建立住院风险评分,并进行验证.以敏感度、特异度均接近70%为截点,评价血运重建对不同风险评分患者预后的影响.结果 (1)6个危险因素进入风险评分模型:包括年龄、收缩压、舒张压、心功能Killip分级、入院时心脏骤停、心电图ST段偏移;(2)拟和优度检验值为0.673,c检验为0.776;(3)将入选的1301例患者分为高风险组和低风险组(风险评分>5.5分、≤5.5分)组,血运重建明显降低ST段抬高心肌梗死患者(STEMI)[OR(95%CI)=0.32(0.11,0.94),x2=5.39,P=0.02]和非ST段抬高ACS患者(NSTEACS)[0R(95%CI)=0.32(0.06,0.94),x2=4.17,P=0.04]高风险组住院不良事件发生率,但是高风险组血运重建率均低于低风险组(STEMI:61.7%、78.3%,P=0.000;NSTEACS:42.0%、62.3%,P=0.000).结论 风险评分能够在入院早期定量预测ACS个体住院不良事件发生率,高风险组血运重建获益最大.

Development and validation of risk score model for acute myocardial infarction in China:prognostic value thereof for in hospital major adverse cardiac events and evaluation of revascularization

Objective To develop a simple risk score model of in-hospital major adverse cardiac events(MACE)including all-cause mortality,new or recurrent myocardial infarction(MI).and evaluate the efficacy about revascularization on patients with different risk.Methods The basic characteristics,diagnosis,therapy,and in-hospital outcomes of 1512 ACS patients from G10bal Registry of Acute Coronary Events(GRACE)study of China were collected to develop a risk score model by multivariable stepwise logistic regression.The goodness-of-fit test and discriminafive power of the final model were assessed respectively.The best cut-off value for the risk score was used to assess the impact of revascularization for ST-elevation Ml(STEMI)and non-ST elevation acute coronary artery syndrome(NSTEACS)on in-hospital outcomes.Results (1)The following 6 independent risk factors accounted for about 92.5%of the prognostic information:age≥80 years(4 points),SBP≤90 mm Hg(6 points),DBP≥90 mm Hg(2points),KiHip Ⅱ(3 points),KillipⅢorⅣ(9 points),cardiac arrest during presentation(4 points),ST-segment elevation(3 points)or depression(5 points)or combination of elevation and depression(4points)on electrocardiogram at presentation.(2)CHIEF risk model was excellent with Hosmer-Lemeshow goodness-of-fit test of 0.673 and c statistics of 0.776.(3)1301 ACS patients previously enrolled in GRACE study were divided into 2 groups with the best cut-0frvalue of 5.5 points.The impact of revascularizafion on the in-hospital MACE of the higber risk subsets was stronger than that of the lower risk subsets both in STEMI[OR(95%CI)=0.32(0.11,0.94),x2=5.39,P=0.02]and NSTEACS[OR(95%CI)=0.32(0.06,0.94),×2=4.17,P=0.04]population.However,beth STEMI(61.7%vs 78.3%,P=0.000)and NSTEACS(42.0%vs 62.3%.P=0.000)patients with the risk scores more than 5.5 points had lower revascularization mtes.Condusion The risk score provides excellent abillty to predict in-hospital death or (re)MI quantitatively and accurately.The patients undergoing revascularization with risk score greater than 5.5 have lower incidence rates of endpoint.