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|本期目录/Table of Contents|

联合GRACE评分和CRUSADE评分对行介入的NSTE-ACS患者预后评估

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2017年第1期
页码:
55-059
栏目:
临床研究
出版日期:
2016-10-05

文章信息/Info

Title:
Combined application of GRACE and CRUSADE in prognostic evaluation of PCI-treated patients with non-ST-elevation acute coronary syndromes
作者:
潘桂林; 张林叶; 李雪梅
（芜湖市第二人民医院心内科，安徽 芜湖 241000）
Author(s):
PAN Gui-lin;  ZHANG Lin-ye;  LI Xue-mei
(Department of Cardiology, Wuhu Second People’s Hospital, Wuhu 241000, Anhui, China)
关键词:
非ST段抬高型急性冠脉综合征; 血管成形术; 经腔; 经皮冠状动脉; GRACE危险评分、CRUSADE危险评分; 病死率
Keywords:
non-ST-elevation acute coronary syndromes;  angioplasty;  transluminal;  percutaneous coronary;  GRACE risk scores;  CRUSADE risk scores;  mortality
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 比较GRACE评分、CRUSADE评分与联合GRACE和CRUSADE评分对于行经皮冠脉支架术的急性非ST段抬高型急性冠脉综合征(Non-ST-segment elevation acute coronary syndrome,NSTE-ACS)患者预后的评估价值。方法 研究纳入明确诊断NSTE-ACS患者320名，均接受经皮冠状动脉介入治疗并置入药物涂层支架。所有患者随访至少1.5年，以GRACE评分141分及CRUSADE评分41分为截点，分为3个组，低危组( GRACE<141;CRUSADE<41)、中危组(GRACE<141,CRUSADE≥41;GRACE≥41,CRUSADE<41)、高危组(GRACE≥141;CRUSADE≥41)，通过统计学方法比较亚组间患者院内及随访期间的死亡与出血事件。结果 从低危组~高危组，患者的临床基线情况逐渐加重的，临床预后结果亦是恶化的，生存分析曲线表明3组病死率是逐渐增加的。GRACE评分、CRUSADE评分和联合评分能较好拟合本组NSTE-ACS患者总事件的分布，Logistic分析和ROC曲线表明联合评分在死亡风险（AUC（联=0.758）>AUC（G=0.750）>AUC（c=0.662））和出血风险（AUC（联=0.770）>AUC（C=0.761）>AUC（G=0.737））上有预测价值，3种方法的评估价值差异均无统计学意义。结论 联合评分在死亡预测和出血风险上均有预测价值，联合评分进行评价是可行的，同时其预测效能最高，有助于指导NSTE-ACS患者早期的危险分层和介入术后的风险预测。
Abstract:
AIM To evaluate the combined use of GRACE and CRUSADE risk stratification schemes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) and each of the scores individually in terms of prognostic prediction. METHODSA total of 320 NSTE-ACS patients treated with PCI were followed for at least 1.5 years. The cohort (according to the GRACE and CRUSADE risk scores) was divided into three groups: lowest risk group (GRACE<141; CRUSADE<41), intermediate risk group (GRACE<141, CRUSADE≥41; GRACE≥41, CRUSADE<41) and highest risk group (GRACE≥141; CRUSADE≥41). Descriptive statistics and multivariate survival analyses were used to compare major cardiovascular events, mortality and bleeding events between groups. RESULTSSurvival analysis differentiated three risk strata. The three risk scores presented a good fit for mortality and bleeding events. Using logistic analysis and ROC curve, combined risk scores showed excellent discriminatory capacity for mortality and bleeding risk and with no statistically significant difference among the three risk scores. CONCLUSIONCombined risk scores are good for prediction of all-cause mortality and bleeding. Combined assessment is a practical and better approach to risk stratification and prognostic prediction in NSTE-ACS patients after PCI.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2015-12-07.
作者简介：潘桂林，主治医师，硕士 Email：guilinpan1982@tom.com
更新日期/Last Update: 2016-10-09