OPT-CAD评分对行直接PCI术后急性心肌梗死患者缺血事件风险的预测研究

Prediction of risk of ischemic events in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention by OPT-CAD score

摘要:

目的 评价中国冠状动脉疾病患者的最佳抗血小板治疗（OPT-CAD）评分对接受直接经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者出院后12个月缺血事件风险的预测价值。方法 选取2016年3月—2019年3月由中国人民解放军北部战区总医院心血管内科收治的1 953例AMI行直接PCI患者为研究对象。根据OPT-CAD评分进行分组，将患者分为低风险组（OPT-CAD评分< 90分）541例和中高风险组（OPT-CAD评分≥90分）1 412例。所观察的主要结局事件是出院后12个月内的缺血事件，包括心源性死亡、心肌梗死及卒中。次要结局事件为12个月内缺血事件的各独立组成成分及全因死亡。绘制受试者工作特征（ROC）曲线，评价OPT-CAD评分对患者院后12个月内（出院后3、6、9、12个月）缺血事件的预测价值。结果 与低风险组患者比较，中高风险组患者12个月的缺血事件、心源性死亡及全因死亡发生率显著增加（P <0.05）。OPT-CAD评分预测患者出院后3、6、9、12个月缺血事件的曲线下面积（AUC）分别为0.767（95% CI：0.701，0.832）、0.769（95% CI：0.709，0.828）、0.756（95% CI：0.700，0.812）、0.764（95% CI：0.710，0.818），均> 0.75。OPT-CAD评分预测患者出院后3个月缺血事件的临界值为125分，敏感性为71%（95% CI：0.596，0.827），特异性为73%（95% CI：0.707，0.747）；6个月缺血事件的临界值为124分，敏感性为72%（95% CI：0.614，0.827），特异性为72%（95% CI：0.696，0.737）；9个月缺血事件的临界值为123分，敏感性为71%（95% CI：0.609，0.806），特异性为70%（95% CI：0.680，0.721）；12个月缺血事件的临界值为123分，敏感性为71%（95% CI：0.626，0.816），特异性70%（95% CI：0.681，0.723）。结论 OPT-CAD评分可以准确且稳定地预测行直接PCI的AMI患者出院后12个月内缺血事件的风险。

Abstract:

Objective To evaluate the predictive value of optimal anti platelet therapy for Chinese patients with coronary artery disease (OPT-CAD) score for the risk of ischemic events within 12 months after discharge in acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary interventions (PCI).Methods A total of 1 953 AMI patients received primary PCI from March 2016 to March 2019 in the General Hospital of Northern Theater Command were selected for the study. According to the OPT-CAD score. Patients were divided into the low-risk group (OPT-CAD score < 90 points, n = 541) and the medium-high risk group (OPT-CAD score ≥ 90 points, n = 1 412). The primary outcomes were ischemic events within 12 months of hospital discharge, including cardiac death, myocardial infarction, and stroke. The secondary outcomes were the independent components of ischemic events and all-cause death within 12 months. And the time-dependent receiver operating characteristic (ROC) curve was used to evaluate the value of the OPT-CAD score in predicting ischemic events at each time point within 12 months.Results Compared with the low-risk group, the incidence of 12-month ischemic events, cardiac death, and all-cause death was higher in the medium-high risk group, and the differences were statistically significant (P < 0.05). The area under ROC curve (AUC) of the OPT-CAD score in predicting ischemic events at each time points within 12 months after discharge was > 0.75. The AUCs of ischemic events at 3, 6, 9 and 12 months were 0.767 (95% CI: 0.701, 0.832), 0.769 (95% CI: 0.709, 0.828), 0.756 (95% CI: 0.700, 0.812) and 0.764 (95% CI: 0.710, 0.818), respectively. The critical value of OPT-CAD score for predicting ischemic events at 3 months was 125 points, with sensitivity of 71% (95% CI: 0.596, 0.827) and specificity of 73% (95% CI: 0.707, 0.747). At 6 months, it was 124 points, sensitivity was 72% (95% CI: 0.614, 0.827), specificity was 72% (95% CI: 0.696, 0.737). At 9 months, it was 123 points, sensitivity was 71% (95% CI: 0.609, 0.806), specificity was 70% (95% CI: 0.680, 0.721). The cut-off for 12-month ischemic events was 123, sensitivity was 71% (95% CI: 0.626, 0.816), and specificity was 70% (95% CI: 0.681, 0.723).Conclusion The OPT-CAD score could accurately and stably predict the risk of ischemic events within 12 months after discharge in AMI patients undergoing primary PCI.