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

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

摘要:

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。

Abstract:

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?