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。
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.
作者
陈诤
张新林
吴韩
谢峻
戴庆
魏钟海
CHEN Zheng;ZHANG Xin-lin;WU Hart;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)
出处
《心脏杂志》
CAS
2018年第4期434-438,共5页
Chinese Heart Journal
