冠状动脉钙化与SYNTAX 评分和GRACE 评分的相关性

目的： 探讨拟诊冠状动脉粥样硬化性心脏病(以下简称冠心病)患者冠状动脉钙化积分、钙化支数与评估 冠状动脉病变严重程度的SYNTAX评分、评估未来心血管事件危险分层的GRACE评分之间的关系。方法： 回顾性 收集2014 年1 月至2019 年4 月在海口市人民医院住院的214 名拟诊冠心病患者的冠状动脉钙化积分、钙化支数、 SYNTAX评分及GRACE 评分等资料。根据冠状动脉钙化积分及钙化支数进行分组，比较各组间SYNTAX评分和 GRACE评分的差异。采用Spearman 相关系数分析冠状动脉钙化积分、钙化支数与SYNTAX评分、GRACE评分的相 关性，二项logistic 回归分析冠状动脉钙化的危险因素，受试者操作特征(receiver operator characteristic，ROC)曲线分 析冠状动脉钙化积分、钙化支数预测冠心病及SYNTAX评分、GRACE评分高危组的价值。结果： Spearman 相关分 析显示冠状动脉钙化积分与SYNTAX评分(r=0.505，P<0.01)、GRACE评分(r=0.195，P<0.01)呈正相关。钙化支数与 SYNTAX 评分(r=0.533，P<0.01)呈正相关，与GRACE 评分无关(r=0.124，P>0.05)。二项logistic 回归显示男性和 SYNTAX评分是冠状动脉发生钙化的独立危险因素(P<0.05)。ROC曲线分析显示冠状动脉钙化积分预测冠心病(AUC= 0.756，P<0.01)和SYNTAX 评分高危组(AUC=0.781，P<0.01)的价值良好，而预测GRACE 评分高危组的价值较低 (AUC=0.698，P<0.01)。钙化支数预测冠心病(AUC=0.763，P<0.01)和SYNTAX评分高危组(AUC=0.868，P<0.01)的 价值良好，而在预测GRACE评分高危组上无统计学意义(AUC=0.601，P=0.07)。结论： 在临床拟诊冠心病患者中， 冠状动脉钙化积分、钙化支数对冠状动脉病变严重程度及未来心血管事件发生风险有较好的预测作用。冠状动脉造 影术前测量冠状动脉钙化积分、钙化支数对预测冠状动脉病变严重程度及制订治疗方案有一定的临床意义。

Association of coronary artery calcification with SYNTAX scores and GRACE

Objective: To investigate the relationship among coronary artery calcification score (CACS), the number of calcification vessels, SYNTAX score and GRACE score in patients with coronary atherosclerotic heart disease (CHD). Methods: The CACS, calcification vessel number, SYNTAX score, and GRACE score were collected or calculated from 214 CHD patients admitted in Haikou People’s Hospital from January 2014 to April 2019. Patients were assigned into several groups according to the CACS and calcification vessel number, and then to compare the differences in SYNTAX and GRACE scores between groups. Spearman correlation coefficient was used to analyze the correlation between CACS or calcification vessel number and SYTAX score or GRACE score. Regression of binary logistic was used to analyze independent risk factors for coronary calcification. The diagnostic values of the CACS and calcification vessel number for predicting CHD, and SYNTAX score and GRACE score high-risk group were evaluated by the receiver operator characteristic (ROC) curve. Results: Spearman correlation analysis showed that CACS was positively correlated with SYTAX score (r=0.505, P<0.01) or GRACE score (r=0.195, P<0.01). The number of calcified vessels was positively correlated with the SYNTAX score (r=0.533, P<0.01), but not with the GRACE score (r=?0.14, P=0.899). Regression of binary logistic showed that male and SYTAX scores were independent risk factors for coronary artery calcification (P< 0.05). The analysis of ROC curve showed that the CACS was of good value in the diagnosis of CHD (AUC=0.756, P<0.01) and SYNTAX score high-risk group (AUC= 0.781, P<0.01), while it was of lower value in the diagnostic of the GRACE score high-risk group (AUC=0.698, P<0.01). The value of calcification vessel number in the diagnosis of CHD (AUC=0.763, P<0.01) and the SYNTAX score high-risk group (AUC=0.868, P< 0.01) was good, but that in the diagnosis of the GRACE score high-risk group (AUC= 0.601, P=0.07) was not statistically significant. Conclusion: In patients with suspected CHD, CACS and calcification vessel number can predict the severity of CHD and the risk of future cardiovascular events. Measuring the CACS and the number of calcification vessels before coronary angiography has certain clinical significance for predicting the severity of coronary lesion and formulating the treatment plan.