GRACE与TIMI评分对ST段抬高型心肌梗死患者预后评估的价值
《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]
- 期数:
- 2018年第4期
- 页码:
- 434-438
- 栏目:
- 临床研究
- 出版日期:
- 2018-04-25
文章信息/Info
- Title:
- Predictive value of GRACE score and TIMI score in the patients of ST-segment elevation myocardial infarction
- Author(s):
- CHEN Zheng; ZHANG Xin-lin; WU Han; XIE Jun; DAI Qing; WEI Zhong-hai
- (Department of Cardiology, Nanjing Drum Tower Hospital Affiliated the Medical School of Nanjing University, Nanjing 210008, Jiangsu, China)
- 关键词:
- ST段抬高型心肌梗死; 全球急性冠状动脉事件注册研究评分; 心肌梗死溶栓治疗评分
- Keywords:
- ST-segment elevation myocardial infarction; Global Registry for Acute Coronary Events score; Thrombolysis in Myocardial Infarction score
- 分类号:
- R541.4
- DOI:
- -
- 文献标识码:
- A
- 摘要:
- 目的 比较全球急性冠状动脉事件注册研究(Global Registry for Acute Coronary Events,GRACE）评分及心肌梗死溶栓治疗评分系统（The Thrombolysis in Myocardial Infarction,TIMI)评分对ST段抬高型心肌梗死（ST segment elevation myocardial infarction，STEMI）患者预后评估的临床价值。方法 280例因STEMI接受急诊经皮冠状动脉介入（percutaneous coronary intervention，PCI）治疗的患者的临床资料，分别计算GRACE及TIMI评分，根据评分结果分为低、中、高危组。随访患者发病后12个月主要心血管不良事件（major adverse cardiac events，MACE）发生情况，通过计算两种评分系统的受试者工作特征曲线（ROC曲线）的面积评估其预测价值，并比较两者预测价值的能力。结果 不论是GRACE评分还是TIMI评分，危险分层越高，患者术后12个月MACE发生率越高（P<0.01），而且TIMI评分的高危组患者MACE的发生率显著高于GRACE评分的高危组患者（P<0.05）。TIMI评分和GRACE评分ROC曲线下面积无统计学差异。GRACE预测MACE的灵敏度为87%，特异度为58%，正确指数（Youden index）为0.45；TIMI 灵敏度为54%，特异度为90%，正确指数为0.44，GRACE评分预测STEMI预后的灵敏度显著高于TIMI评分（87% vs. 54%,P<0.01），而其特异度显著低于TIMI评分（58% vs. 90%,P<0.01），两组正确指数的差异则无统计学意义(0.45 vs. 0.44)。结论 两种评分体系总体预测能力的差异无统计学意义。但GRACE评分灵敏度高，而TIMI评分特异度高。
- Abstract:
- AIM The study was performed to compare the predictive value between thrombolysis in myocardial infarction (TIMI) scores and global registry for acute coronary events (GRACE) scores in patients with ST-Elevation Myocardial Infarction (STEMI). METHODS 280 consecutive STEMI patients who had undergone percutaneous coronary intervention (PCI) were enrolled in the current study. According to the two scores system, the patients were divided into low risk, moderate risk, and high risk groups, respectively. All the patients were followed up for 12 months to learn the major adverse cardiac events (MACE) rate. The receiver operating characteristic (ROC) curve was depicted for the two score system to evaluate and to compare the predictive capability. RESULTS The patients with high risk group of GRACE and TIMI scores had higher incidence of MACE at 12 months (P<0.01). Moreover, the high risk group of TIMI score had significantly higher incidence of MACE than that in high risk group of GRACE score (P<0.05). However, there was no significant difference between the area under ROC of GRACE score and TIMI score. The GRACE score predicted MACE with the sensitivity of 87%, specificity of 58% and Youden index of 0.45. The TIMI score had the sensitivity of 54%, the specificity of 90%and the Youden index of 0.44. Compared with TIMI score, GRACE score had higher sensitivity (87% vs. 54%, P<0.01) and lower specificity (58% vs. 90%, P<0.01). There were no difference in the Youden index (0.45 vs. 0.44) between the two groups. CONCLUSION The two risk scores show similar predictive capacity of MACE for the overall patient cohort at 12 months. GRACE score has a high sensitivity, while TIMI score has a high specificity.
参考文献/References
[1]Cannon CP.Evidence-based risk stratification to target therapies in acute coronary syndromes[J].Circulation,2002,106(13):1588-1591.
[2]Morrow DA,Antman EM,Charlesworth A,et al.TIMI risk score for ST-elevation myocardial infarction:A convenient,bedside,clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy[J].Circulation,2000,102(17):2031-2037.
[3]Granger CB,Goldberg RJ,Dabbous O,et al.Predictors of hospital mortality in the global registry of acute coronary events[J].Arch Intern Med,2003,163(19):2345-2353.
[4]Jaffe AS.Third universal definition of myocardial infarction[J].Clin Biochem,2013,46(1-2):1-4.
[5]De Luca G,Suryapranata H,van THA,et al.Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty:implications for early discharge[J].Circulation,2004,109(22):2737-2743.
[6]Fox KA,Dabbous OH,Goldberg RJ,et al.Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome:prospective multinational observational study(GRACE)[J].BMJ,2006,333(7578):1091.
[7]Widimsky P,Wijns W,Fajadet J,et al.Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries[J].Eur Heart J,2010,31(8):943-957.
[8]Littnerova S,Kala P,Jarkovsky J,et al.GRACE Score among Six Risk Scoring Systems(CADILLAC, PAMI,TIMI,Dynamic TIMI,Zwolle)Demonstrated the Best Predictive Value for Prediction of Long-Term Mortality in Patients with ST-Elevation Myocardial Infarction[J].PLOS ONE,2015,10(4):e123215.
[9]Huang S,Chen Y,Lu T,et al.Application of the Sequential Organ Failure Assessment score for predicting mortality in patients with acute myocardial infarction[J].Resuscitation,2012,83(5):591-595.
[10]Gibson CM,Pinto DS,Murphy SA,et al.Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality[J].J Am Coll Cardiol,2003,42(9):1535-1543.
[11]Timóteo AT,Papoila AL,Lopes JP,et al.Is it possible to simplify risk stratification scores for patients with ST-segment elevation myocardial infarction undergoing primary angioplasty?[J].Revista Portuguesa de Cardiologia,2013,32(12):967-973.
[12]Wei X,Liu Y,He P,et al.Additive prognostic value of left ventricular ejection fraction to the TIMI risk score for in-hospital and long-term mortality in patients with ST segment elevation myocardial infarction[J].J Thromb Thrombolysis,2017,43(1):1-6.
[13]Gonzalez-Pacheco H,Arias-Mendoza A,Alvarez-Sangabriel A,et al.The TIMI risk score for STEMI predicts in-hospital mortality and adverse events in patients without cardiogenic shock undergoing primary angioplasty[J].Arch Cardiol Mex,2012,82(1):7-13.
[14]Acet H,Erta F,Bilik MZ,et al.The relationship of TIMI risk index with SYNTAX and Gensini risk scores in predicting the extent and severity of coronary artery disease in patients with STEMI undergoing primary percutaneous coronary intervention[J].Ther Adv Cardiovasc Dis,2015,9(5):257-266.
[15]Truong QA,Cannon CP,Zakai NA,et al.Thrombolysis in Myocardial Infarction(TIMI)Risk Index predicts long-term mortality and heart failure in patients with ST-elevation myocardial infarction in the TIMI 2 clinical trial[J].Am Heart J,2009,157(4):673-679.
[16]Damman P,Woudstra P,Kuijt WJ,et al.Short- and Long-Term Prognostic Value of the TIMI Risk Score after Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction[J].J Interv Cardiol,2013,26(1):8-13.
[17]Selvarajah S,Fong AYY,Selvaraj G,et al.An Asian Validation of the TIMI Risk Score for ST-Segment Elevation Myocardial Infarction[J].PLoS One,2012,7(7):e40249.
[18]Lev EI,Kornowski R,Vaknin-Assa H,et al.Comparison of the Predictive Value of Four Different Risk Scores for Outcomes of Patients With ST-Elevation Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention[J].Am J Cardiol,2008,102(1):6-11.
[19]Scruth EA,Cheng E,Worrall-Carter L.Risk score comparison of outcomes in patients presenting with ST-elevation myocardial infarction treated with percutaneous coronary intervention[J].Eur J Cardiovasc Nurs,2013,12(4):330-336.
[20]Brkovic V,Dobric M,Beleslin B,et al.Additive prognostic value of the SYNTAX score over GRACE,TIMI,ZWOLLE,CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention[J].Int J Cardiovasc Imaging,2013,29(6):1215-1228.
[21]Kozieradzka A,Kamiński KA,Maciorkowska D,et al.GRACE, TIMI, Zwolle and CADILLAC risk scores-Do they predict 5-year outcomes after ST-elevation myocardial infarction treated invasively?[J].Int J Cardiol,2011,148(1):70-75.
备注/Memo
- 备注/Memo:
- 收稿日期：2017-11-03.通讯作者：魏钟海，副主任医师，主要从事心脏介入研究 Email：weizhnjjs@yeah.net 作者简介：陈诤，硕士生，住院医师 Email：chenzheng870717@126.com
常用功能
统计/Statistics
- 摘要浏览/Viewed814
- 评论/Comments
