摘要
目的：探讨三种不同评分方法（sYNTAx、GRC、GRACE）预测冠脉3支病变（3VD）患者终点事件（即心源性死亡、再发急性冠脉综合征和需再次血运重建）的准确度。方法：收集经冠状动脉造影诊断为3支病变的患者共70例。根据入院时的各项临床指标及冠脉造影结果分别对每例患者进行SYNTAX评分、GRC分层和GRACE评分并对评分分值分组，采用Y0检验和Fisher精确概率法比较各组终点事件的发生率。且对SYNTAX评分、GRC危险分层及GRACE评分分别绘制RoC曲线，计算曲线下面积（AUC），分别比较和分析3种评分方法预测终点事件的准确度。结果：①GRACE评分各组终点事件的发生率差异无统计学意义（P〉0．05）；SYNTAX评分和GRC分层，中危组与低危组终点事件的发生率均有显著性差异（P〈0．01），而高危组与中危组终点事件的发生率均无统计学差异（P〉0．05）。②GRACE评分、GRC分层、SYNTAX评分3种方法预测3VD患者6个月终点事件的准确度均呈依次递增趋势，其准确度分别是（AUC：0．622，95％CI：0．490～0．753）和（AUC：0．688，95％CI：0．560～0．815），（AUC：0．740，95％CI：0．620～0．859）。SYNTAx评分在21．5分时预测6个月终点事件敏感度和特异度均较好，分别是0．619和0.821。③GRACE评分、GRC分层、SYNTAX评分3种方法预测3VD患者6个月终点事件的准确度差异无统计学意义（P〉0．05）。结论：①SYNTAX评分预测6个月终点事件的准确度优于GRACE危险评分和GRC分层。GRc分层预测6个月终点事件的准确度优于GRACE危险评分。GRACE评分能一定程度预测3VD患者6个月发生终点事件可能。但准确度不高。SYNTAx评分和GRC分层中，中危组与低危组终点事件的发生率均有显著性差异（P〈0．01）。②SYNTAX评分在21．5分时，预测6个月终点事件敏感度和特异度均较好，可以指导临床，兼顾实用性和准确性，SYNTAX评分在临床工作中可作为首选。
[Abstract] Objective：To study the accuracy of three different risk stratifications to predict 6 months end- point events （cardiac mortality, acute coronary syndrome recurrence, requiring revascularization）in patients with 3VD. Methods： We studied 70 patients with 3VD diagnosed with corollary arteriography examination o we fol- lowed up the endpoint events within 6 months of the patients with 3VD. SYNTAX, GRACE, GRC risk scores were calculated according to the clinical indicators and angiographic outcomes on admission. All patients were di- vided according to their scores and compared the endpoint events rate among the groups. We described ROC curves about those three risk stratifications, and computed the areas under the curves, then compared the accuracy of those three risk stratification methods. Results：（1）The incidence of endpoint events among the three groups in GRACE showed no significant difference （P 〉0.05）. The differences above between low risk and intermediate risk groups were all significant（P 〈 0.01） in GRC and SYNTAX. But no difference was found between high risk and intermediate risk groups in them（P 〉0.05）.（2） The accuracy that those three risk stratifieations（SYN- TAX,GRACE,GRC）predicted 6 months endpoint events in patients with 3 VD tended to increase gradually, Their accuracy were（AUC：0. 622, 95%CI：0.490--0. 753）, （AUC：0. 688, 95%CI：0. 560--0. 815）, （AUC：0. 740, 95 % C1：0. 620--0. 859）respectively, both the sensitivity and the specificity of the SYNTAX risk score in 21.5 points which predicted 6 months endpoint events manifested good, the sensitivity and the specificity of SYNTAX were0. 619 and 0. 821respectively. （3）There was no statistically significant difference in prediciting ac- curacy of the endpoint within 6 months of the patients with 3VD with the three methods（P 〉 0.05）. Conclu- sions： （1）The accuracy of SYNTAX to predict 6 months endpoints is superior to GRACE and GRC, The accuracy of GRC to predict 6 months endpoints is superior to GRACE. But the accuracy of GRACE is low that can predict 6 months endpoints to some extent. There both were significant difference between low risk and intermediate risk groups in SYNTAX and GRC. （2） Both the sensitivity and the specificity of the SYNTAX risk score in 21. 5 points which predicted 6 months endpoint events manifested good. Considering practicability and accuracy , SYNTAX should be first choice in clinic.
出处
《内蒙古医学杂志》
2013年第3期275-279,共5页
Inner Mongolia Medical Journal
关键词
3支病变
危险分层
预后
3 - vessel disease
Risk stratification
Prognosis
