GRACE评分与80岁以上急性冠状动脉综合征患者冠状动脉狭窄严重程度的相关性

目的研究≥80岁急性冠状动脉综合征(ACS)患者的急性冠状动脉事件的全球性注册研究(GRACE)评分与冠状动脉狭窄程度的相关性。方法连续入选470例≥80岁ACS患者,根据Gensini评分分为轻度狭窄组(141例)和重度狭窄组(329例),并以同期因胸痛住院而冠状动脉造影未见明显狭窄的66例≥80岁患者作为对照组。比较3组临床情况、合并疾病和GRACE评分,分析GRACE评分与Gensini评分的相关性。结果随着冠状动脉狭窄程度的加重,心率、空腹血糖、血清肌酐和尿素氮明显升高(P0.01);3组患者糖尿病、慢性肾功能不全、心肌梗死病史差异显著(P0.05)。冠状动脉重度狭窄组急性ST段抬高型心肌梗死(STEMI)和急性非ST段抬高型心肌梗死(NSTEMI)患病率明显高于轻度狭窄组和对照组(P0.05);3组患者GRACE评分差异显著,与Gensini评分呈正相关(r=0.356,P=0.000)。结论≥80岁ACS患者GRACE评分与冠状动脉狭窄程度呈正相关。高龄ACS患者的冠状动脉狭窄程度越重,GRACE评分越高,预后越差。

Association of GRACE score with severity of coronary artery in acute coronary syndrome patients over eighty years old

Objective To assess the association of GRACE score with the severity of coronary artery in acute coronary syn- drome （ACS） patients over 80 years old. Methods A total of 470 patients older than 80 years with ACS and 66 control patients old- er than 80 years who received successful coronary angiography were included in this study. The patients were grouped into mild stenosis group （141） and severe stenosis group （329） according to the Gensini score. The patients＇clinical characteristics,complications and GRACE scores were compared; the relationship between GRACE score and Gensini score was analyzed. Results The patients were classified into 3 groups; their heart rate （HR）,fasting blood glucose （FBG）,serum creatinine （CRE）,blood urea nitrogen （BUN） increased （ P 〈 0.01） as their coronary artery stenosis aggravated. The proportion of diabetes mellitus （DM）, chronic renal insufficiency and myocardial infarction demonstrated significant difference （P 〈 0.05）. The ratios of acute ST segment elevated myocardial infarction （STEMI） and non-ST segment elevated myocardial infarction （NSTEMI） were significant higher than mild stenosis group and control group （P 〈 0.05）. The GRACE score was significant difference between 3 groups （ P = 0.000）. The patients＂ GRACE score increased （P 〈 0.01） with the aggravation of coronary artery stenosis. GRACE score was positive correlation with Gensini score. Conclusion GRACE scores are positive correlated with the severity of coronary artery stenosis in ACS patients over eighty years old. The prognosis worsens as coronary artery stenosis become more severe.