GRACE、HEART和TIMI评分对急性胸痛患者主要心血管不良事件的预测价值

目的 比较全球急性冠状动脉事件注册（GRACE）、心脏评分法（HEART）及心肌梗死溶栓疗法（TIMI）评分对急性胸痛患者发生主要不良心血管事件（MACE）的预测价值。方法 选取湖北省十堰市国药东风总医院收治的378例急性胸痛患者作为研究对象，按照6周内是否发生MACE分为MACE组33例和非MACE组345例，比较两组患者临床资料的差异，Logistic回归分析影响MACE发生的危险因素；ROC曲线观察3种评分方法对MACE的预测效能，Kaplan-Meier法计算发生MACE的累积风险函数。结果 MACE组年龄、高血压病史、GRACE评分、HEART评分、TIMI评分、空腹血糖、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、C-反应蛋白（CRP）高于非MACE组，血氧饱和度、收缩压、舒张压低于非MACE组（P?<0.05）。Logistic回归显示年龄、GRACE评分、HEART评分、TIMI评分是急性胸痛患者发生MACE的危险因素（均P?<0.05）。 HEART评分预测MACE的AUC为0.915（95% CI：0.882，0.941），高于GRACE评分的AUC 0.709（95% CI：0.660，0.754]和TIMI评分的AUC 0.778（95% CI：0.733，0.819）]，其特异性94.8%，敏感性75.8%。生存分析显示，HEART高分组MACE发生风险高于中分组和低分组（P?<0.05）。结论 HEART评分是急性胸痛患者危险分层和预测MACE发生的较好指标。

Clinical value of GRACE, HEART and TIMI score to predict major adverse cardiac events in acute chest pain patients

Objective To assess the predictive value of GRACE, HEART and TIMI score in major adverse cardiac events in acute chest pain patients. Methods A total of 378 acute chest pain patients, admitted to hospitals were included, were divided into MACE group (n?=?33) and non-MACE group (n?=?345) based on whether MACE occurred within 6 weeks. Comparing clinical data between two groups, the risk factors related to MACE was analyzed by Logistic regression, cumulative hazard functions of MACE was calculated by Kaplan-Meier method, and predictive value of three scores on MACE was assessed by ROC curve. Results Age, hypertension, GRACE scores, HEART scores, TIMI scores, fasting blood glucose, TC, LDL-C and CRP in the MACE group was signifincantly higher than those in the non-MACE group, meanwhile, SpO2, systolic blood pressure and diastolic blood pressure was markedly lower than those in the non-MACE group, and the differences between two groups were statistically significant (all P?