联合GRACE评分、TIMI-AF评分预测心房颤动并 急性冠脉综合征介入治疗患者死亡风险

目的 探讨GRACE评分、TIMI-AF评分对心房颤动（AF）伴急性冠脉综合征（ACS）经皮冠状动脉介入治疗(PCI)患者院内及远期死亡风险的预测价值。方法 共纳入北京地区12家三甲医院AF伴ACS行PCI干预患者2429例行GRACE评分、TIMI-AF评分，观察院内及远期全因死亡，通过比较受试者工作（ROC）曲线下面积（AUC），评估二种评分及二者联合对该队列患者死亡风险的预测价值。结果 院内共34例患者死亡，对于院内死亡风险GRACE评分AUC为0.826(P=0.000)，TIMI-AF评分AUC为0.747(P=0.000),二者比较无差异；二者联合AUC为0.843(P=0.000),二者联合相比GRACE评分无统计学差异，但优于TIMI-AF评分。平均随访3.19 1.52年，期间共270例患者死亡，对于远期死亡风险GRACE评分AUC为0.660 (P=0.000),TIMI-AF评分AUC为0.659(P=0.001), 二者比较无差异；二者联合AUC为0.683(P=0.000)，二者联合优于单一GRACE评分，TIMI-AF评分。结论 在本队列AF并ACS经PCI干预患者中，GRACE评分及TIMI-AF评分均可预测院内短期及长期死亡风险，但在远期死亡风险方面二者的预测能力均下降，二者联合能提高对远期死亡风险的预测能力。

Combination of GRACE Score and TIMI-AF Score to Predict In-Hospital and Long-term Mortality Risk in Patients with Atrial Fibrillation and Acute Coronary Syndromes Underwent Percutaneous Coronary Intervention

Objiective Objective to investigate the predictive value of GRACE score and TIMI-AF score for in-hospital and long-term mortality in patients with atrial fibrillation and acute coronary syndromes underwent percutaneous coronary intervention(PCI). Method A total of 2429 patients with atrial fibrillation and acute coronary syndromes underwent PCI In the Beijing area of 12 tertiary hospitals were enrolled, their GRACE scores and TIMI-AF scores were calculated, the in-hospital and long-term all cause death were observed, by comparing the area under the receiver operating curve (AUC),we assess the predictive value of the two scores for motality risk in the cohort. Result There were 34 deaths in the hospital, There were a total of 270 deaths who were followed up 3.19 1.52 years. To assess in-hospital death risk, the AUC of GRACE score was 0.826 (P=0.000), and the TIMI-AF score was 0.747 (P=0.000), no significant differences between the two scores. Combination of the two scores was 0.843 (P=0.000), no significant difference compared to GRACE, but better than TIMI-AF scroe. To assess long-term mortality risk, the AUC of GRACE score was 0.660 (P=0.000), and the TIMI-AF score was 0.659(P=0.001), no statistical difference between the two groups. Combination of the two scores was 0.683(P=0.000),superior to the single GRACE score or the TIMI-AF score. Conclusion In this cohort , GRACE score and TIMI-AF score can predict in-hospital and long-term risk of death, but their predictive value in the long-term risk was decline. The combination of the two scores can improve the ability to predict the long-term risk of death.