HEART评分在急性非创伤性胸痛近期MACE预测中的应用价值

目的探讨HEART评分在急性非创伤性胸痛30 d心血管不良事件（major adverse cardiovascular events,MACE)预测中的临床价值。 方法选择急性非创伤性胸痛患者645例，排除由于肿瘤、风湿等导致的疼痛患者84例和失访患者11例，纳入研究共550例。对所有患者分别进行HEART评分和GRACE评分，并随访30 d，记录MACE的发生情况。 结果550例急性非创伤性胸痛患者中， 30 d内发生MACE 82例（14.9%）。MACE组年龄、吸烟率、合并高血压病率、合并冠心病率、合并糖尿病率及入院时HEART评分、GRACE评分与非MACE组差异有统计学意义（P＜0.05）。Logistic回归分析显示年龄、HEART评分、GRACE评分是急性非创伤性胸痛患者30 d内发生MACE的独立危险因素。绘制HEART评分、GRACE评分预测胸痛患者30 d内发生MACE的ROC曲线，HEART评分曲线下面积高于GRACE评分（P＜0.05）；HEART评分高危组MACE发生率高于GRACE评分高危组，HEART评分中危组MACE发生率高于GRACE评分中危组，低危组MACE发生率低于GRACE评分低危组（P＜0.05），表明HEART评分评定为低危患者MACE发生风险更低，且预测的中危和高危患者发生MACE发生风险更高。 结论HEART评分在急性非创伤性胸痛30 d MACE预测中具有较高的临床价值。

Application value of HEART score in predicting short-term MACE of acute non-traumatic chest pain

ObjectiveTo explore the clinical value of HEART score in predicting 30-day major adverse cardiovascular events(MACE) of acute non-traumatic chest pain.MethodsOf 645 patients with acute non-traumatic chest pain, 84 patients with pain caused by tumors and rheumatism and 11 patients who were lost to follow-up were excluded. Thus, a total of 550 patients were included in the study. HEART score and GRACE score were calculated respectively in all patients, and the incidence of MACE was recorded at 30-d follow-up.ResultsOf all 550 patients with acute non-traumatic chest pain, 82(14.9%) developed MACE within 30 days. There were significant differences in age, smoking rate, combined hypertension rate, coronary heart disease rate, diabetes rate, HEART score and GRACE score between MACE group and non-MACE group(P＜0.05). Logistic regression analysis showed that age, HEART score and GRACE score were independent risk factors for 30-day MACE in patients with acute non-traumatic chest pain. ROC curves of HEART score and GRACE score were drawn to predict 30-day MACE in patients with chest pain. The area under the curve of HEART score was higher than that of GRACE score(P＜0.05). The incidence of MACE in high-risk group by HEART score was higher than that in high-risk group by GRACE score, the incidence of MACE in moderate-risk group by HEART score was higher than that in moderate-risk group by GRACE score, and the incidence of MACE in low-risk group was lower than that in low-risk group by GRACE score(P＜0.05). This suggested that patients rated as low risk according to the HEART score had a lower risk of MACE, and those rates as moderate or high risk had a higher risk of MACE.ConclusionHEART score has a high clinical value in predicting 30-day MACE in the patients with acute non-traumatic chest pain.