摘要
目的比较心肌梗死溶栓治疗临床试验(TIMI)评分和全球急性冠状动脉事件注册(GRACE)评分对急性非ST段抬高型心肌梗死(NSTEMI)患者在院期间死亡率的预测价值。方法本研究全部数据均来自前瞻性、多中心的大规模临床注册研究——中国心肌梗死注册登记研究。该研究在2013年1月至2014年9月共连续入选全国31个省、市和自治区107家医院的NSTEMI患者5 896例。对NSTEMI患者进行TIMI评分和GRACE评分,通过Mann-Whitney检验比较两种评分系统对NSTEMI患者院内死亡率的预测价值。结果在5 896例NSTEMI患者中,4 020例(68.2%)为男性,年龄为(65.4±12.1)岁,住院天数为10.0(7.0,13.0)d。住院死亡353例(6.0%);213例(3.6%)发生过院前心脏骤停;651例(11.0%)的患者接受了再灌注治疗,再灌注治疗时间为529.5(256.0,1 065.0)min,其中645例(10.9%)接受了急诊经皮冠状动脉介入治疗,6例(0.1%)接受了急诊冠状动脉旁路移植术。接受他汀、β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂、醛固酮受体拮抗剂的治疗比例分别为94.8%(5 587例)、71.7%(4 228例)、65.5%(3 864例)和26.0%(1 533例)。用受试者工作特征模型计算TIMI评分和GRACE评分对院内死亡率预测价值的曲线下面积分别为0.559(95%CI 0.532~0.586)和0.793(95%CI 0.768~0.818),二者比较差异有统计学意义(P<0.001)。结论 GRACE评分对中国NSTEMI患者院内死亡率的预测价值优于TIMI评分。
Objective To evaluate the prognostic value of the thrombolysis in myocardial infarction (TIMI) and global registry of acute coronary events (GRACE) risk scores for in-hospital mortality in Chinese non-ST-segment elevation myocardial infarction (NSTEMI) patients. Methods Data of present study derived from the prospective, multi-center registry trial of Chinese AMI (CAMI). Among 31 provinces, municipalities or autonomous districts in China, at least one tertiary and secondary hospital was selected. From January 2013 to September 2014, 5 896 consecutive non-ST-segment elevation myocardial infarction patients who were admitted to 107 hospitals within 7 days of symptom onset were enrolled. For each patient, TIMI and GRACE risk scores were calculated using specific variables collected at admission. Their prognostic value was evaluated by the endpoint of in-hospital mortality. Results Among 5 896 NSTEMI patients (age was (65.4±12.1) years old), 68.2%(n=4 020) were males. The in-hospital mortality was 6.0%(n=353) and the median length of hospital stay was 10.0 (7.0, 13.0) days. The incidence of pre-hospital cardiac arrest was 3.6%(n=213) among 5 896 NSTEMI patients. Six hundreds and forty five patients (10.9%) received primary percutaneous coronary intervention, and 6 patients underwent emergent coronary artery bypass grafting surgery (0.1%), and the median time of reperfusion was 529.5 (256.0, 1 065.0) minutes. The prescription percentage of statins,β-blocker, angiotensin converting enzyme inhibitors or angiotensin Ⅱ receptor blockers, and aldosterone antagonists were 94.8%(n=5 587), 71.7%(n=4 228), 65.5%(n=3 864) and 26.0%(n=1 533) respectively. The area under the curve of GRACE risk score for in-hospital mortality (0.7930 (95%CI 0.767-0.818)) was better than that of TIMI risk score (0.5588 (95%CI 0.532-0.586), P<0.001). Conclusion GRACE risk score demonstrates better predictive accuracy than TIMI risk score for in-hospital mortality in NSTEMI patients in this patient cohort.
作者
吴超
高晓津
赵延延
杨进刚
杨跃进
许海燕
严若华
吴元
乔树宾
王杨
李卫
孙毅
金辰
春语诗
代表中国急性心肌梗死注册登记研究组
Wu Chao;Gao Xiaojin;Zhao Yanyan;Yang Jingang;Yang Yuejin;Xu Haiyan;Yan Ruohua;Wu Yuan;Qiao Shubin;Wang Yang;Li Wei;Sun Yi;Jin Chen;Chun Yushi;on behalf of China Acute Myocardial Infarction (CAMI) Registry Research Group(Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, China)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2019年第4期297-304,共8页
Chinese Journal of Cardiology
基金
国家"十二五"科技支撑计划(2011BAI11B02)
国家卫生和计划生育委员会公益性行业专项(201402001)
中国医学科学院医学与健康科技创新工程基金(2016-I2M-1-009).
关键词
心肌梗死
医院死亡率
危险评分
Myocardial infarction
Hospital mortality
Risk score
