GRACE评分对急性冠脉综合征患者心源性死亡风险的预测价值

目的探讨GRACE评分对急性冠脉综合征(ACS)患者住院期间心源性死亡风险的预测价值。方法回顾性纳入2009年1月至2010年12月住院治疗的ACS患者160例,住院期间(28 d内)发生心源性死亡患者60例(死亡组),同期住院存活患者100例(对照组)。收集患者入院基线时资料,并进行GRACE评分。采用ROC曲线计算GRACE评分对预测心源性死亡敏感性和特异性。结果死亡组患者的GRACE评分为(179.00±39.74)分,而对照组为(128.93±30.88)分,两组相比具有统计学差异(P0.01)。两组患者GRACE评分危险分层构成中,死亡组高危层比率明显高于对照组,而中低危层低于对照组,差异有显著统计学意义(P0.01)。对于ACS患者,GRACE评分在158分时,对应ROC曲线下面积最大为0.821(95%CI:0.743~0.899,P0.01),预测在院期间心源性死亡的敏感性为0.75,特异度0.85。结论 GRACE危险评分方法可以用于评估ACS患者住院期间心源性死亡风险;当GRACE评分在158分时,预测住院发生心源性死亡的敏感性和特异性均较好。     

急性心肌梗死溶栓效果与冠脉造影特征分析

目的 探讨急性心肌梗死(AMI)患者静脉溶栓再灌注效果与冠状动脉病变影像学特征即冠脉病变支数、梗死相关动脉(infarct-related artery,IRA)分布部位、形态、狭窄程度与长度)的相关性.方法 收集2001年1月至2007年8月在广西医科大学第一附属医院心血管病研究所住院且行尿激酶静脉溶栓的84例AMI患者资料进行回顾性分析.采用单因素与多因素方法分析冠脉造影病变特征即病变支数、IRA分布部位、形态改变、狭窄程度和长度等因素与再通是否相关.结果 按间接再通指征判断再通率为64.29%.单因素检验显示IRA狭窄长度、及分布部位,均进入回归方程(P值均＜0.05),病变支数及IRA狭窄程度未能进入回归方程(P＞0.05).多因素logistic回归分析结果提示尿激酶溶栓再通与IRA狭窄长度患者呈负相关;与IRA分布部位相关性无统计学意义(P＞0.05).结论 (1)AMI患者静脉尿激酶溶栓再通效果与IRA狭窄长度呈负相关;(2)冠脉病变支数、IRA分布部位及IRA狭窄程度等因素与再通效果无统计学意义相关性.

Abstract：

Objective To evaluate the angiographic findings and the therapeutic effect of thrombolysis in AMI (acute myocardial infarction) patients. Method A retrospective study were carried out in consecutive eighty-four inpatients with AMI treated with intravenous thrombolysis and coronary angiography was taken within a week after illness onset from January 2000 to August 2007. The patients were divided into successful recanalization group and non-recanalization group. Single factor χ2 test and multi-factor logistic regression analysis were applied to observe the relationship among the angiographic features of IRA (infarct-related artery including the number of stnosis, the location of stenosis, the severity of stenosis and the morphological changes) and treatment effect of intravenous urokinase thrombolysis. Results (1) Single factor χ2 test showed that location and the extent of lesion of IRA were eligible to enter the logistic regression formula (P ＜ 0.05),whereas the number of lesions and the severity of IRA's stenosis were not eligible to enter the logistic regression formula (P ＞ 0. 05). (2) Multi-factor logistic regression analysis showed that the extent of lesion of IRA was the only factor that had a negative impact on the therapeutic effect of intravenous thrombolysis.Conclusions The study shows that the extent of lesion of IRA is the only factor that has a negative impact on the therapeutic effect of intravenous thrombolysis; The number, the location of lesion and the severity of stenosis of IRA have no impact on the therapeutic effect of intravenous thrombolysis in AMI.     

冠状动脉造影病变特征与急性冠脉综合征猝死的相关性分析

目的 分析急性冠脉综合征(acute coronary syndrome,ACS)猝死(sudden cardiac death,SCD)患者冠状动脉造影基本影像学特征,探讨其作为ACS猝死危险评估的价值.方法 收集2000-01～2010-12在广西医科大学第一附属医院心研所收治的ACS发生猝死患者共52例,于猝死发作前后1个月内曾行选择性冠状动脉造影.分析冠脉造影病变的特征(病变支数、分布部位、IRA形态改变等因素)与ACS猝死的相关性.结果.冠脉造影,单支、双支和多支病变者分别为15、14和23例,合并左主干病变者7例;IRA狭窄程度为完全闭塞、次全闭塞、严重狭窄、临界狭窄者分别为29、14、6和3例;IRA的冠脉病变呈弥漫性、管状和局限性分别为29、13和10例;IRA分布部位,LAD、RCA、LCX分别为16、30和6例,合并左主干病变者7例,IRA发现血栓14例.冠脉病变支数、IRA长度、合并左主干病变、IRA狭窄程度及IRA分布差异有统计学意义(P值均<0.05);冠脉病变支数、IRA狭窄程度、IRA分布对冠心病猝死发生影响具有统计学意义(P<0.05).结论.ACS患者猝死多存在多支和严重的冠脉病变基础,IRA病变狭窄程度较重,需要紧急血运重建.