非ST段抬高急性冠状动脉综合征的预后危险因素与危险评分

目的：探讨非 ST 段抬高急性冠状动脉综合征的预后危险因素及不同危险评分的预测预后价值。方法：2003年1月至2004年4月期间,连续入院且资料完整的非 ST 段抬高急性冠状动脉综合征患者337例,随访 30天与1年的终点事件(心原性死亡和非致命性心肌梗死)。根据入院时的临床指标分别计算每例患者的心肌梗死溶栓治疗临床试验(TIMI)评分和全球急性冠状动脉事件注册(GRACE)评分,进行多变量回归分析,筛查30天和1年时心血管事件的预测危险因素(根据有无终点事件发生分为30天事件组、30天无事件组和1年事件组、1年无事件组)；分析 TIMI 评分和 GRACE 评分的预后价值,以及与血运重建的相互关系。结果：随访1年共发生终点事件57例(16.9%)。死亡19例(5.6%),非致死性心肌梗北38例(11.3%)。预测危险因素包括：年龄、血肌酐升高、入院时心率、左心室射血分数＜0.40和高血压。TIMI 评分和 GRACE 评分方法预测30天终点事件的敏感性和特异性相似,但 GRACE 评分预测1年终点事件的敏感性和特异性优于 TIMI 评分,GRACE 评分＞ 133分的患者进行血运重建治疗后远期终点事件发生率明显下降(P=0.01)。结论：除传统危险因素外,血肌酐水平升高是非 ST 段抬高急性冠状动脉综合征患者预后的重要危险因素；GRACE 评分较 TIMI 评分能更好的预测非 ST 段抬高急性冠状动脉综合征患者1年的终点事件危险,GRACE 评分＞133分的患者进行血运重建的获益更多。

Investigation of Risk Scores and Prognostic Value in Patients With Acute Coronary Syndrome Without ST-Segment Elevation

Objective:To determine the risk factors and compare two risk scores in the evaluation of prognosis in patients with acute cor- onary syndromes(ACS) without ST-segment elevation (NSTE ACS). Methods:The patients of NSTE ACS were included in the study who were admitted to hospitals consecutively from Jan.2003 to Apr.2004.The TIMI and GRACE risk scores were calculated according to the baseline characteristics on admission.The risk factors for endpoint events (cardiac death and nonfatal myocardial infarction) in 30 days and 1 year were analyzed by logistic re- gression model.The effects of TIMI and GRACE in the evaluation of the benefits of revascularization in this cohort were com- pared. Results:The incidences of combined cardiovascular events within 30 days and 1 year were 7.4% (death 2.1%,MI 5.3%) and 16.9% (death 5.6%,MI 11.3%),respectively.Multivariate logistic regression analysis showed that age,lower ejection fraction of left ventricle,increased creatinine and troponin I levels were all associated with an increase of cardiovascular events within 30 days.They,except troponin I,were independent predictive factors for the increases of cardiovascular events in 1 year. The sensitivity and specificity of GRACE score was superior to the TIMI score.We found a statistically significant relation between the risk stratified by the GRACE or TIMI and revascularization,with a better prognosis in high-risk patients. Conclusions:Besides traditional risk factors,the increased creatinine level is an important predictive factor for short-term and long-term prognosis of non-ST segment elevation ACS.The GRACE risk score demonstrated greater predictive value for death and MI.For the cardiovascular event at 1 year,GRACE seems to be superior to TIMI.High-risk patients by GRACE benefit much more from revascularization.