NSTE-ACS患者GRACE评分和NLR与冠状动脉病变的关系

目的 研究非ST段抬高型急性冠脉综合征（NSTE-ACS）患者全球急性冠状动脉事件注册（GRACE）危险评分、中性粒细胞/淋巴细胞比值（NLR）与冠状动脉病变程度的相关性。 方法 回顾性分析228例在我院住院并行冠脉造影的NSTE-ACS患者。根据GRACE评分将患者分为低危组、中危组及高危组。采用Gensini积分量化冠脉病变程度,按Gensini积分三分位间距将患者分为轻度、中度及重度病变组。分析GRACE评分、NLR与是否与不同程度的冠状动脉病变相关。 结果 ①GRACE危险分层中危组及高危组NLR及Gensini积分较低危组升高（P<0.01）,3支及左主干病变发生率高于低危组（P<0.01）。冠脉重度病变组GRACE危险评分、NLR均高于轻度病变组（P<0.01）。②GRACE危险评分及NLR与Gensini积分呈正相关关系。GRACE危险评分联合NLR对重度冠脉病变有中等预测价值（ROC曲线下面积 0.725,95%CI 0.653~0.798,P<0.01）。 结论 GRACE危险评分、NLR与NSTE-ACS患者冠状动脉病变有良好相关性,可作为严重冠状动脉病变早期预测因子。     

联合GRACE评分、TIMI-AF评分预测心房颤动并 急性冠脉综合征介入治疗患者死亡风险

目的 探讨GRACE评分、TIMI-AF评分对心房颤动（AF）伴急性冠脉综合征（ACS）经皮冠状动脉介入治疗(PCI)患者院内及远期死亡风险的预测价值。方法 共纳入北京地区12家三甲医院AF伴ACS行PCI干预患者2429例行GRACE评分、TIMI-AF评分,观察院内及远期全因死亡,通过比较受试者工作（ROC）曲线下面积（AUC）,评估二种评分及二者联合对该队列患者死亡风险的预测价值。结果 院内共34例患者死亡,对于院内死亡风险GRACE评分AUC为0.826(P=0.000),TIMI-AF评分AUC为0.747(P=0.000),二者比较无差异;二者联合AUC为0.843(P=0.000),二者联合相比GRACE评分无统计学差异,但优于TIMI-AF评分。平均随访3.19 1.52年,期间共270例患者死亡,对于远期死亡风险GRACE评分AUC为0.660 (P=0.000),TIMI-AF评分AUC为0.659(P=0.001), 二者比较无差异;二者联合AUC为0.683(P=0.000),二者联合优于单一GRACE评分,TIMI-AF评分。结论 在本队列AF并ACS经PCI干预患者中,GRACE评分及TIMI-AF评分均可预测院内短期及长期死亡风险,但在远期死亡风险方面二者的预测能力均下降,二者联合能提高对远期死亡风险的预测能力。     

非ST段抬高型急性冠脉综合征患者脑钠尿肽与GRACE危险评分的相关性及其预测价值

目的:探讨非ST段抬高型急性冠状动脉综合征（non-ST-segment elevated acute coronary syndrome,NSTE-ACS）患者血浆脑钠尿肽（brain natriuretic peptide,BNP）的水平与全球急性冠状动脉事件注册（global registry of acute coronary events,GRACE）评分及危险分层的关系,分析BNP对NSTE-ACS患者近期（6个月）发生主要不良心脏事件(major adverse cardiac event,MACE)的预测价值。方法: 入选2011年12月~2013年2月在我院心内科住院的NSTE-ACS患者194例,其中不稳定型心绞痛（unstable angina,UA）90例,急性非ST段抬高型心肌梗死（non-ST segment elevated myocardial infraction,NSTEMI）104例。入院后测定BNP及血脂水平。采用GRACE危险评分标准计算患者GRACE评分并进行危险分层,低危组59例,中危组65例,高危组75例。住院期间进行常规治疗。患者出院后随访6个月,观察终点为发生MACE的情况。结果: 将NSTE-ACS患者按GRACE评分进行危险分层,高危组BNP高于中危组和低危组（均P<0.01）,中危组BNP显著高于低危组（P<0.01）。血浆BNP水平与GRACE评分呈正相关（r=0.656,P<0.05）。随着GRACE评分越高,血浆BNP水平亦增高,住院期间、随访期MACE发生率也随之增高。结论: GRACE评分越高,BNP水平越高,在NSTE-ACS患者中,联合运用GRACE评分和BNP水平检测,在对其进行早期危险分层、评估预后方面有重要临床价值。     

非ST段抬高急性冠脉综合征患者血清单核细胞/高密度脂蛋白比值与GRACE评分和SYNTAX评分相关性

目的探讨血清单核细胞/高密度脂蛋白(HDL)比值(MHR)与非ST段抬高急性冠脉综合征(NSTE-ACS)患者全球急性冠状动脉事件注册(GRACE)评分和SYNTAX评分的关系。方法纳入2018年因胸痛在心血管内科住院治疗,并行冠状动脉造影检查证实为NSTE-ACS患者236例。根据患者入院时GRACE评分,将患者分为GRACE评分低危、中危和高危组。入院后抽取患者的血常规及血脂生化检查,比较三组之间的MHR值,采用多因素Logistic回归分析MHR值与GRACE评分的关系。对所有患者进行冠状动脉造影检查,根据患者的冠状动脉病变特点,采用SYNTAX评分,将患者分为SYNTAX评分低危、中危及高危组,比较三组之间的MHR值。结果与低危及中危组相比,GRACE评分高危组患者的MHR水平明显升高(P0.05)。MHR与GRACE评分呈线性正相关(r=0.783,P0.05),多因素Logistic回归分析显示高MHR值是GRACE评分高危的独立预测因子。SYNTAX评分高危组患者的MHR值与中危组及低危组相比无明显差异(P0.05)。结论高MHR水平与NSTE-ACS患者GRACE评分的危险分组独立且显著相关,有助于判断NSTE-ACS患者的危险分层及短期预后。     

不同预后评分系统对老年NSTE-ACS患者远期预后的评估价值

目的探索grace评分和syntax评分对老年非ST段抬高急性冠状动脉综合征(NSTE-ACS)患者远期预后的评估价值。方法老年NSTE-ACS患者400例,随访时间16~24个月,完成随访392例,其中药物治疗组205例,置入支架组162例,冠脉搭桥术组25例。各组有计算grace评分和syntax评分,根据评分情况分为低危组、中危组和高危组。Pearson法分析grace和syntax评分的相关性;Kaplan-Meier法进行生存分析;Cox比例风险回归模型进行各因素分析;通过ROC曲线下面积比较预测准确性。结果 grace评分与syntax评分之间呈正相关(r=0.562,P<0.01)。grace评分得出的高危、中危、低危组患者心血管事件发生率依次降低(P<0.01)。syntax得出的高危组和中危组患者心血管事件发生率明显高于低危组(P<0.05),但高危与中危组之间差异无统计学意义(P>0.05)。grace评分和syntax评分对老年NSTE-ACS患者远期预后均有重要的评估价值。对grace评分、syntax评分和两者联合评分行ROC曲线分析显示,两者均对老年NSTE-ACS患者远期心血管事件风险有良好的预测价值,但在95%CI有明显重叠。结论 grace和syntax评分存在相关性,均对老年NSTE-ACS患者远期预后有重要预测价值,两者联用可在一定程度上提升预测准确性。grace评分适合对老年NSTE-ACS患者远预后进行危险程度分层。     

GRACE危险评分与拟诊非ST段抬高急性冠脉综合征病人冠脉病变程度的相关性研究

目的探讨GRACE评分与冠脉病变之间的相关性。方法收集2014年9月—2015年1月在山西医科大学第一医院住院期间的非ST段抬高急性冠脉综合征(NSTE-ACS)病人102例,根据GRACE评分系统将病人分为低危组(n=63)、中危组(n=30)及高危组(n=9)。所有的病人在入院期间均于5d内行冠脉造影术。结果低危组Gensini评分为0(0,10),中危组为5.3(0,20.6),高危组为38.5(12.3,57.8),3组比较差异有统计学意义(P0.001),低危组与高危组相比差异有统计学意义(P0.005),中危组与高危组相比差异有统计学意义(P0.005)。相关性分析显示,GRACE评分与Gensini评分具有相关性(r=0.334,P0.001)。结论 GRACE评分在拟诊NSTE-ACS病人冠脉病变程度的评估方面有重要价值。     

急性冠脉综合征患者GRACE评分与冠脉病变的相互关系

目的 探讨急性冠脉综合征（ACS）患者全球急性冠状动脉事件注册（GRACE）评分与冠状动脉病变程度的关系,评价GRACE评分对冠状动脉病变预测的价值.方法 收集2008年5月至2010年10月住院的ACS患者共360例,对其进行GRACE评分.以评分差异分组,分为高危组、中危组和低危组,分析不同组别中患者冠状动脉病变的严重程度,以及与GRACE评分的关系.结果 随着GRACE评分分值的增加,ACS患者冠状动脉狭窄支数及狭窄程度呈增加的趋势.结论 GRACE评分对ACS患者冠状动脉病变支数、狭窄严重程度有一定的预测价值.     

CRUSADE评分与HAS-BLED评分评估非ST段抬高型急性冠脉综合征患者双重抗血小板治疗后出血风险的价值比较

目的比较CRUSADE评分与HAS-BLED评分评估非ST段抬高型急性冠脉综合征(NSTEACS)患者双重抗血小板治疗后出血风险的价值。方法回顾性分析清华大学第一附属医院自2014年2月~2018年2月间治疗的671例NSTE-ACS患者的临床资料,均实施双重抗血小板治疗并行CRUSADE评分及HAS-BLED评分,观察患者短期和远期主要出血事件发生情况,比较不同CRUSADE、HAS-BLED危险分级的短期和远期主要出血事件发生率,分析CRUSADE评分和HAS-BLED评分预测主要出血事件发生的效能。结果 671例患者中院内短期主要出血事件发生率1.49%;随访12个月,随访率93.59%,随访远期主要出血事件发生率8.92%;不同CRUSADE、HAS-BLED危险分级的院内短期和随访远期主要出血事件发生率比较,差异均有统计学意义(P0.05);CRUSADE评分与HAS-BLED评分预测院内短期主要出血事件发生的ROC曲线AUC比较,差异无统计学意义(P0.05);预测随访远期主要出血事件发生的ROC曲线AUC比较,差异有统计学意义(P0.05)。结论在接受双重抗血小板治疗的NSTE-ACS患者中,CRUSADE评分与HAS-BLED评分评估院内短期出血风险的价值相当,CRUSADE评分在评估随访远期出血风险方面较HAS-BLED评分有显著优势。     

GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征患者的远期预后评估

目的:明确GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征(NSTE-ACS)远期预后的评估价值。方法:回顾性分析2009-01至2014-01住院诊断为NSTE-ACS的患者共784例,其中单纯药物治疗组410例,支架组325例,CABG组49例。计算患者的GRACE评分和SYNTAX评分,按照评分分为低、中、高危三组。GRACE评分和SYNTAX评分的关系采用Pearson相关分析;生存分析采用Kaplan-Meier法;用Cox比例风险模型进行单因素及多因素分析。计算受试者工作特征(ROC)曲线下面积比较预测方法的优劣性。结果:研究完成随访784例,随访中位时间为47.7个月。Pearson相关分析显示,GRACE评分和SYNTAX评分存在较弱的正相关(r=0.40,P0.01);生存分析结果表明,GRACE评分得出的低、中、高危三组的主要不良心血管事件(MACE)发生率逐渐升高(依次为13.81%、23.64%和36.55%,P0.001);SYNTAX评分得出的中、高危组的MACE发生率(分别为39.29%和37.93%)均高于低危组(23.99%),但中危组和高危组之间的差异无统计学意义(P0.05)。Cox回归和ROC分析显示,GRACE评分和SYNTAX评分对NSTE-ACS的长期预后评估均有重要价值。将GRACE评分、SYNTAX评分及GRACE和SYNTAX联合评分进行ROC曲线分析后发现,三者对NSTE-ACS患者远期MACE风险均有良好的预测价值,但三者的95%可信区间明显重叠,预测价值的差异无统计学意义。结论:GRACE评分和SYNTAX评分存在相关性,二者对NSTE-ACS的远期预后评估均有重要价值,预测价值无明显差异,即使两者联合也并不提高预测价值。利用GRACE评分对NSTE-ACS患者的远期预后进行低、中、高危分层是适宜的。     

CRUSADE评分、HAS-BLED评分预测心房颤动并PCI患者院内及远期出血风险的比较

目的:探讨CRUSADE评分、HAS-BLED评分对心房颤动(AF)伴急性冠状动脉综合征(ACS)经冠状动脉介入治疗(PCI)患者主要出血的预测价值。方法:纳入北京地区12家三甲医院AF伴ACS并PCI干预患者共2 421例行CRUSADE评分、HAS-BLED评分,观察院内及远期主要出血事件,通过比较受试者工作(ROC)曲线下面积(AUC),评估2种评分对该队列患者主要出血风险的预测价值。结果:院内共观察到23例主要出血事件,平均随访(3.22±1.53)年,随访期间共发生45例主要出血事件。对于院内出血风险CRUSADE评分AUC为0.737(P=0.000),HAS-BLED评分AUC为0.682(P=0.003)。对于远期出血风险CRUSADE评分AUC为0.693(P=0.000),HAS-BLED评分AUC为0.649(P=0.001)。在含口服抗凝治疗亚组对于院内出血风险CRUSADE评分AUC为0.507(P=0.956),HASBLED评分AUC为0.563(P=0.599)。对于远期出血风险CRUSADE评分AUC为0.490(P=0.930),HASBLED评分AUC为0.661(P=0.147)。结论:在本队列中,AF并ACS经PCI干预患者,抗栓方案以双联抗血小板为主,CRUSADE评分及HAS-BLED评分均可预测院内短期及长期出血风险,但在远期出血风险方面二者的预测价值均有下降,CRUSADE评分有优于HAS-BLED的趋势。对于含口服抗凝剂抗栓治疗的患者CRUSADE评分及HAS-BLED评分对院内及远期出血风险均无预测价值。     

Comparison of the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION bleeding scores in ACS patients undergoing PCI: insights from a cohort of 4939 patients in China

Background The CRUSADE, ACTION and ACUITY-HORIZONS scores are commonly used for predicting in-hospital major bleeding events in patients with acute coronary syndrome (ACS), but the homogeneous nature of these models'' population limits simple extrapolation to other local population. We aimed to compare the performance of the three risk models in Chinese patients. Methods We evaluated the performance of the three predicting scores for predicting in-hospital major bleeding events defined by thrombolysis in myocardial infarction (TIMI) serious (major and minor) episodes, in a cohort of Chinese ACS patients with either non-ST-elevation ACS (NSTE-ACS) or ST-elevation myocardial infarction (STEMI). Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow test and C-statistic, respectively. We compared the predictive accuracy of the risk scores by the Delong non-parametric test. Results TIMI serious bleeding rate was 1.1% overall (1.9% and 0.86% for STEMI and NSTE-ACS, respectively). The CRUSADE, ACTION and ACUTIY-HORIZONS scores showed an adequate discriminatory capacity for major bleeding: in overall patients, the C-statistic was 0.80, 0.77, and 0.70, respectively; in NSTE-ACS patients, the C-statistic was 0.73, 0.72, and 0.64, respectively; in STEMI patients, the C-statistic was 0.91, 0.92, and 0.75, respectively. The C-statistic for the ACUITY-HORIZONS model was significantly lower than those of the CRUSADE and ACTION scores for the prediction of TIMI serious bleeding in overall patients (compared with CRUSADE, z = 3.83, P = 0.02; compared with ACTION, z = 3.51, P = 0.03); in NSTE-ACS patients (compared with CRUSADE, z = 2.37, P = 0.01; compared with ACTION, z = 2.11, P = 0.04), and in STEMI patients (compared with CRUSADE, z = 2.6.77, P = 0.02; compared with ACTION, z = 7.91, P = 0.002). No differences were observed when the CRUSADE and ACTION models were compared to each other, regardless of overall patients (z = 0.68, P = 0.31) and both of ACS types (NSTE-ACS, z = 0.52, P = 0.60), and STEMI patients (z = 0.36, P= 0.74). However, the three risk scores all overestimated the absolute major bleeding risk in each risk stratification in our study. For example, the predicted rate of CRUSADE score at high risk stratification was 11.9% vs. an actual rate of 5.3%. Conclusions The CRUSADE and ACTION scores had a greater calibration and discrimination for in-hospital major bleeding compared with the ACUITY-HORIZONS score in Chinese patients with ACS undergoing PCI. However, they all overestimated the bleeding risk rate for Chinese populations. Calibration of these risk scores would be useful for the generalization in Chinese populations.     

Síndromes coronárias agudas sem supradesnivelamento‐ST nos octogenários: aplicabilidade dos scores GRACE e CRUSADE

IntroductionAssessment of ischemic and bleeding risk is critical for the management of elderly patients with acute coronary syndromes, but it has been little studied.ObjectiveThis study aims to assess the applicability of the GRACE and CRUSADE scores in patients aged ≥80 years with non‐ST‐elevation acute coronary syndrome (NSTE‐ACS), and to identify the main predictors of in‐hospital mortality and major bleeding in this population.MethodsWe analyzed 544 patients aged ≥80 years with NSTE‐ACS included in the Portuguese Registry on Acute Coronary Syndromes and identified the predictors of in‐hospital mortality and major bleeding during hospitalization. Prediction models were created for these endpoints, then compared with the GRACE and CRUSADE scores, and their applicability to the study population was assessed.ResultsUse of coronary angiography was associated with reduced risk of in‐hospital mortality, without increasing risk of major bleeding (OR 0.2, 95% CI 0.006‐0.49, p=0.001). Major bleeding was an independent predictor of in‐hospital mortality (OR 10.9, 95% CI 2.36‐50.74, p=0.002), and was associated with comorbidities and pharmacological therapy during hospitalization. The GRACE score showed good diagnostic accuracy for in‐hospital mortality (AUC 0.75, 95% CI 0.63‐0.87, p<0.001), but the CRUSADE score had weak discriminatory capacity for major bleeding (AUC 0.51, 95% CI 0.30‐0.63, p=0.942), unlike our prediction model (AUC 0.68, 95% CI 0.52–0.84, p=0032).ConclusionsThe GRACE score is suitable for risk assessment in octogenarians with NSTE‐ACS, but the CRUSADE score is inadequate, and new scores are required to assess bleeding risk in this age‐group.     

Kommentar zu den Leitlinien der Europ?ischen Gesellschaft für Kardiologie (ESC) zur Diagnostik und Therapie des akuten Koronarsyndroms ohne persistierende ST-Streckenhebung

Non-ST-elevation acute coronary syndromes (NSTE-ACS) comprise a wide spectrum of disease severities and mortality risks. Next to establishing the diagnosis, clinical management therefore also requires risk stratification in order to adequately select the intensity and urgency of further work-up and treatment. In September 2011 updated recommendations for the management of patients with NSTE-ACS were published by the European Society of Cardiology. Major innovations included the use of highly sensitive troponin assays, including the resulting possibility of establishing a fast-track protocol, the routine recommendation of echocardiography in all patients and the introduction of coronary computed tomography (CT) angiography as a possibility to rule out coronary disease in selected individuals. The importance of risk stratification is emphasized throughout the document and routine use of the GRACE risk score as well as the CRUSADE bleeding risk score is encouraged. The recommendations reflect the availability of new antithrombotic agents and new timelines for invasive work-up are introduced. This comment in German summarizes the ESC guidelines and highlights relevant amendments as compared to the previous version.     

An analysis of patients receiving emergency CAG without PCI and the value of GRACE score in predicting PCI possibilities in NSTE-ACS patients

Background There are patients who underwent emergency coronary angiography (CAG) but did not receive percutaneous coronary intervention (PCI). The aim of this study was to analyze these reasons. Methods This is a single-center retrospective study. We recruited 201 consecutive patients who received emergency CAG but did not receive PCI. To investigate the value of the Global Registry of Acute Coronary Events (GRACE) score in predicting PCI possibilities in non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients, we recruited 80 consecutive patients who presented with NSTE-ACS and received emergency CAG as well as emergency PCI. Results Among the 201 patients who received emergency CAG but did not receive PCI, 26% patients had final diagnosis other than coronary heart disease. In the patients with significant coronary artery stenosis, 23 patients (11.5%) were recommended to coronary artery bypass grafting (CABG), one patient (0.5%) refused PCI; 13 patients (6.5%) with significant thrombus burden were treated with glycoprotein IIb/IIIa receptor antagonist; 74 patients (36.8%) were treated with drug therapy because no severe stenosis (> 70%) was present in the crime vessel. Moreover, 80 of the 201 patients were presented with NSTE-ACS (excluding those patients with final diagnosis other than coronary heart disease, excluding those patients planned for CABG treatment), referred as non PCI NSTE-ACS. When comparing their GRACE scores with 80 consecutive patients presented with NSTE-ACS who received emergency CAG as well as emergency PCI (referred as PCI NSTE-ACS), we found that PCI NSTE-ACS patients had significantly higher GRACE scores compared with non PCI NSTE-ACS patients. We then used Receiver Operator Characteristic Curve (ROC) to test whether the GRACE score is good at evaluating the possibilities of PCI in NSTE-ACS patients. The area under the curve was 0.854 ± 0.030 (P < 0.001), indicating good predictive value. Furthermore, we analyzed results derived from ROC statistics, and found that a GRACE score of 125.5, as a cut-off, has high sensitivity and specificity in evaluating PCI possibilities in NSTE-ACS patients. Conclusions Our findings indicate that the GRACE score has predictive value in determining whether NSTE-ACS patients would receive PCI.     

运用CRUSADE评分系统评估非ST段抬高性急性冠脉综合征患者双重抗血小板治疗后的出血风险简

目的 运用CRUSADE评分系统对非ST段抬高性急性冠脉综合征（non-ST-elevation acute coronary syndromes,NSTE-ACS）患者抗栓治疗后的出血风险进行评估.方法 选择2009年1月至2011年6月在清华大学第一附属医院住院的NSTE-ACS患者共245例,对每例患者行CRUSADE评分并进行危险分层,其中包括不稳定型心绞痛（unstable angina,UA）患者115例[男68例,女47例,年龄为（63.5±3.6）岁],非ST段抬高性心肌梗死（non-ST-elevation myocardial infarction,NSTEMI）患者130例[男79例,女51例,年龄为（66.2±9.1）岁].所有患者均服用双重抗血小板药物（阿司匹林与氯吡格雷联用）1年,观察期间的出血发生率.结果 245例NSTE-ACS患者中共有23例发生主要出血事件,出血发生率为9％,其中消化道出血的发生率最高,占整个出血人群的50％以上,其次为泌尿系统出血,脑出血和肺出血发生率相对较低.在115例UA患者中1年内共有7例发生了主要出血事件,总的出血发生率为6％,由极低危组到极高危组出血发生率依次为0％、0％、0.9％、1.7％、3.5％;130例NSTEMI患者中1年内有16例发生了主要出血事件,总的出血发生率为12％,由极低危组到极高危组出血发生率依次为0.8％、0.8％、1.5％、3.1％、6.0％.高危组和极高危组的出血风险显著高于其余各组,差异有统计学意义（P＜0.05）.结论 随着危险分层级别（CRUSADE评分）增大,出血发生率呈增加趋势,CRUSADE评分系统对于NSTE-ACS患者出院后长期双联抗血小板治疗的出血风险有良好的评估价值.     

冠状动脉经皮介入术治疗高龄非ST段抬高型急性冠脉综合征的疗效

目的 评价经皮冠状动脉介入（PCI）治疗在高龄（>80岁）非ST段抬高型急性冠脉综合征(NSTE-ACS)中的安全性和有效性。方法 经冠状动脉造影检查证实冠脉狭窄程度在70%~90%的NSTE-ACS患者175例,根据是否介入治疗分为,介入组84例（发病后3~7 d接受择期PCI）,药物组91例（未行PCI术,单纯优化药物治疗）。观察记录两组患者临床特征、1年随访期间主要心血管不良事件。结果 介入组与药物组相比,介入组能显著降低心因住院、血运重建、心绞痛复发风险,在全因死亡、脑梗死、严重的出血事件方面差异无统计学意义。结论 对于高龄NSTE-ACS患者接受PCI术是安全、有效的。     

老年急性非ST段抬高型心肌梗死GRACE评分高危与低危患者经皮冠状动脉介入治疗近期与远期疗效

目的：探讨老年（≥60岁）急性非ST段抬高型心肌梗死（NSTEMI）患者早期经皮冠状动脉介入治疗（PCI）的必要性及安全性。方法收集2011年1月至2012年12月期间在沈阳军区总医院心血管内科住院诊断为NSTEMI并且接受PCI治疗的439例老年（≥60岁）患者。依据入院时的临床检查及化验指标,对每名患者进行全球急性冠状动脉事件注册（GRACE）评分,以评分结果进行分组（低危组评分≤140、高危组评分＞140）,比较两组的冠状动脉病变特点、PCI的术后并发症发生率、住院期间及术后1年内主要不良心脏事件（MACE）和终点事件的发生率。结果两组患者共入选439例,其中男性273例,女性166例,男性平均年龄68.4岁,女性平均年龄70.3岁。比较两组冠状动脉病变特点,高危组更多合并双支或三支血管病变（P＜0.05）,差异有统计学意义（P＜0.05）。比较两组总的终点事件发生率,全因死亡终点事件发生率和住院期间死亡终点事件发生率,差异均无统计学意义（P＞0.05）。亚组分析：两组年龄≥80岁患者之间以及高危组中年龄≥80岁与＜79岁两者之间总的终点事件发生率的比较,差异无统计学意义（P＞0.05）。高危组≥80岁与＜79岁两者之间的死亡（包括非心源性及心源性）终点事件发生率比较,差异无统计学意义（P＞0.05）。结论 GRACE评分是一种应用广泛、快速的心血管疾病评价方法,可以对临床预测并指导患者的早期干预,尤其对于老年NSTEMI患者进行早期干预治疗具有指导意义,并对其冠状动脉血管病变程度及复杂性有一定预测价值。     

Improved predictive value of GRACE risk score combined with platelet reactivity for 1-year cardiovascular risk in patients with acute coronary syndrome who underwent coronary stent implantation

Both high platelet reactivity (HPR) and Global Registry of Acute Coronary Events (GRACE) risk score have moderate predictive value for major adverse cardiovascular disease (CVD) events in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI), whereas the prognostic significance of GRACE risk score combined with platelet function testing remains unclear. A total of 596 patients with non-ST elevation ACS who underwent PCI were enrolled. The P2Y₁₂ reaction unit (PRU) value was measured by VerifyNow P2Y₁₂ assay and GRACE score was calculated by GRACE risk 2.0 calculator. Patients were stratified by a pre-specified cutoff value of PRU 230 and GRACE score 140 to assess 1-year risk of cardiovascular death, non-fatal myocardial infarction (MI), and stent thrombosis. Seventy-two (12.1%) patients developed CVD events during 1-year follow-up. Patients with CVD events had a higher PRU value (244.6 ± 50.9 vs. 203.7 ± 52.0, p < 0.001) and GRACE score (185.2 ± 45.6 vs. 149.7 ± 40.1, p < 0.001) than those without events. Multivariate logistic analysis showed that both platelet reactivity and GRACE score were associated with 1-year CVD risk independently. Compared to patients with normal platelet reactivity (NPR) and GRACE score < 140, those with HPR and GRACE score ≥ 140 were exposed to significantly elevated CVD risk (HR: 5.048; 95% CI: 2.268–11.237; p < 0.001). Adding platelet reactivity on the top of GRACE risk score yielded superior risk predictive capacity beyond GRACE score alone, which is shown by improved c-statistic value (0.871, p = 0.002) as well as net reclassification improvement (NRI 0.263, p < 0.001) and integrated discrimination improvement (IDI 0.018, p = 0.002). In patients with NSTE-ACS who underwent PCI, high on-treatment platelet reactivity and high GRACE score led to greater risk of adverse CVD events. The combination of platelet function testing and GRACE score predicted 1-year CVD risk better.     

非ST段抬高型急性冠脉综合征患者血清胱抑素C水平与GRACE评分的关系

目的：探讨非ST段抬高型急性冠脉综合征（NSTE—ACS）血浆胱抑素（Cys）C水平与全球急性冠状动脉事件注册（GRACE）评分的关系。方法：入选符合标准的NSTE—ACS患者155例,分为非ST段抬高型心肌梗死（NSTEA—MI）组和不稳定型心绞痛（UAP）组,入院后进行GRACE评分,同时第2天清晨空腹采集肘静脉血检测CysC,与87例非冠心病患者进行对照比较。结果：NSTE—ACS患者CysC、GRACE评分与非冠心病组比较均出现显著性升高（P〈0．05）,而且血清CysC水平随GRACE危险程度增加而显著升高（P〈0．05）,两者呈显著正相关（r=0．55,P〈0．01）。结论：NSTE-ACS患者CysC水平与GRACE评分密切相关。