Background There are patients who underwent emergency coronary angiography （CAG） but did not receive percutaneous coronary intervention （PCI）. The aim of this study was to analyze these reasons. Methods This is a ...Background There are patients who underwent emergency coronary angiography （CAG） but did not receive percutaneous coronary intervention （PCI）. The aim of this study was to analyze these reasons. Methods This is a single-center retrospective study. We recruited 201 consecutive patients who received emergency CAG but did not receive PCI. To investigate the value of the Global Registry of Acute Coronary Events （GRACE） score in predicting PC1 possibilities in non-ST segment elevation acute coronary syndrome （NSTE-ACS） pa- tients, we recruited 80 consecutive patients who presented with NSTE-ACS and received emergency CAG as well as emergency PC1. Re- sults Among the 201 patients who received emergency CAG but did not receive PCI, 26% patients had final diagnosis other than coronary heart disease. In the patients with significant coronary artery stenosis, 23 patients （11.5%） were recommended to coronary artery bypass grafting （CABG）, one patient （0.5%） refused PCI; 13 patients （6.5%） with significant thrombus burden were treated with glycoprotein IIb/IIIa receptor antagonist; 74 patients （36.8%） were treated with drug therapy because no severe stenosis （〉 70%） was present in the crime vessel. Moreover, 80 of the 201 patients were presented with NSTE-ACS （excluding those patients with final diagnosis other than coronary heart disease, excluding those patients planned for CABG treatment）, referred as non PCI NSTE-ACS. When comparing their GRACE scores with 80 consecutive patients presented with NSTE-ACS who received emergency CAG as well as emergency PCI （referred as PCI NSTE-ACS）, we found that PCI NSTE-ACS patients had significantly higher GRACE scores compared with non PCI NSTE-ACS patients. We then used Receiver Operator Characteristic Curve （ROC） to test whether the GRACE score is good at evaluating the possibilities of PCI in NSTE-ACS patients. The area under the curve was 0.854 ~ 0.030 （P 〈 0.001）, indicating good predictive value. Furthermore, we analyzed results derived from ROC statistics, and found that a GRACE score of 125.5, as a cut-off, has high sensitivity and specificity in evaluating PCI possibilities in NSTE-ACS patients. Conclusions Our findings indicate that the GRACE score has predictive value in determining whether NSTE-ACS patients would receive PCI.展开更多
BACKGROUND GRACE and SYNTAX scores are important tools to assess prognosis in non-STelevation acute coronary syndrome(NSTE-ACS).However,there have been few studies on their value in patients receiving different types ...BACKGROUND GRACE and SYNTAX scores are important tools to assess prognosis in non-STelevation acute coronary syndrome(NSTE-ACS).However,there have been few studies on their value in patients receiving different types of therapies.AIM To explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies.METHODS The data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups.A total of 195 patients who received agents alone comprised the medication group,156 who received medical therapy combined with stents comprised the stent group,and 35 patients who were given agents and underwent coronary artery bypass grafting(CABG)comprised the CABG group.General information was compared among the three groups.GRACE and SYNTAX scores were calculated.The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events(MACEs)was analyzed.Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS.Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model.RESULTS The incidence of MACE increased with the elevation of GRACE and SYNTAX scores(all P<0.05).The incidence of MACE was 18.5%,36.5%,and 42.9%in the medication group,stent group,and CABG group,respectively.By comparison,the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups(all P<0.05).The incidence of MACE was 6.2%,28.0%and 40.0%in patients with a low GRACE score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 31.0%,30.3%and 42.9%in patients with a medium GRACE score in the medication group,stent group,and CABG group,respectively(P>0.05).The incidence of MACE was 16.9%,46.2%,and 43.8%in patients with a high GRACE score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 16.2%,35.4%and 60.0%in patients with a low SYNTAX score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 37.5%,40.9%,and 41.7%in patients with a medium SYNTAX score in the medication group,stent group,and CABG group,respectively(P>0.05).MACE incidence was 50.0%,75.0%,and 25.0%in patients with a high SYNTAX score in the medication group,stent group,and CABG group,respectively(P<0.05).Univariate Cox regression analyses showed that both GRACE score(hazard ratio[HR]=1.212,95%confidence interval[CI]:1.083 to 1.176;P<0.05)and SYNTAX score(HR=1.160,95%CI:1.104 to 1.192;P<0.05)were factors influencing MACE(all P<0.05).Multivariate Cox regression analyses showed that GRACE(HR=1.091,95%CI:1.015 to 1.037;P<0.05)and SYNTAX scores(HR=1.031,95%CI:1.076 to 1.143;P<0.05)were independent predictors of MACE(all P<0.05).CONCLUSION GRACE and SYNTAX scores are of great value for evaluating the prognosis of NSTE-ACS patients,and prevention and early intervention strategies should be used in clinical practice targeting different risk scores.展开更多
【目的】评价GRACE评分对急诊科急性胸痛患者30 d心血管不良事件(MACE)的预测价值。【方法】使用前瞻性观察研究的方法纳入2016年1月1日至2016年4月1日在我院急诊科首诊急性胸痛的患者,记录患者临床基本资料,完成GRACE评分的计算,并对...【目的】评价GRACE评分对急诊科急性胸痛患者30 d心血管不良事件(MACE)的预测价值。【方法】使用前瞻性观察研究的方法纳入2016年1月1日至2016年4月1日在我院急诊科首诊急性胸痛的患者,记录患者临床基本资料,完成GRACE评分的计算,并对入组的患者进行30 d MACE的随访。【结果】入选209例患者,男性110例(52.63%),女性99例(47.37%),年龄范围20~98岁,平均年龄(65.28±16.85)岁。发生MACE 12例,其中急诊死亡2例,住院期间死亡3例,出院后死亡6例,再发心肌梗死1例。与非MACE组相比,MACE组患者年龄,BMI,住院人数,CCU住院例数、GRACE评分均高于非MACE组患者,两组比较具有统计学差异(P<0.05);GRACE评分预测急性胸痛30 d MACE的ROC曲线下面积(95%CI)为0.819(0.735-0.902),最佳敏感性为0.92,特异性为0.65。不同GRACE评分危险分层中对30 d心血管不良事件概率分别为0.95%(低危)、6.67%(中危)、18.92%(高危)。【结论】GRACE评分对急性胸痛患者30展开更多
基金The study was supported by grants from the National Natural Science Foundation of China （No. 81300076, 81400833）, Beijing Natural Science Foundation （No. 7132195） and Discovery Cardiovascular Research Grant, Chinese Medical Doctor Association （No. DFCMDA201306）.
文摘Background There are patients who underwent emergency coronary angiography （CAG） but did not receive percutaneous coronary intervention （PCI）. The aim of this study was to analyze these reasons. Methods This is a single-center retrospective study. We recruited 201 consecutive patients who received emergency CAG but did not receive PCI. To investigate the value of the Global Registry of Acute Coronary Events （GRACE） score in predicting PC1 possibilities in non-ST segment elevation acute coronary syndrome （NSTE-ACS） pa- tients, we recruited 80 consecutive patients who presented with NSTE-ACS and received emergency CAG as well as emergency PC1. Re- sults Among the 201 patients who received emergency CAG but did not receive PCI, 26% patients had final diagnosis other than coronary heart disease. In the patients with significant coronary artery stenosis, 23 patients （11.5%） were recommended to coronary artery bypass grafting （CABG）, one patient （0.5%） refused PCI; 13 patients （6.5%） with significant thrombus burden were treated with glycoprotein IIb/IIIa receptor antagonist; 74 patients （36.8%） were treated with drug therapy because no severe stenosis （〉 70%） was present in the crime vessel. Moreover, 80 of the 201 patients were presented with NSTE-ACS （excluding those patients with final diagnosis other than coronary heart disease, excluding those patients planned for CABG treatment）, referred as non PCI NSTE-ACS. When comparing their GRACE scores with 80 consecutive patients presented with NSTE-ACS who received emergency CAG as well as emergency PCI （referred as PCI NSTE-ACS）, we found that PCI NSTE-ACS patients had significantly higher GRACE scores compared with non PCI NSTE-ACS patients. We then used Receiver Operator Characteristic Curve （ROC） to test whether the GRACE score is good at evaluating the possibilities of PCI in NSTE-ACS patients. The area under the curve was 0.854 ~ 0.030 （P 〈 0.001）, indicating good predictive value. Furthermore, we analyzed results derived from ROC statistics, and found that a GRACE score of 125.5, as a cut-off, has high sensitivity and specificity in evaluating PCI possibilities in NSTE-ACS patients. Conclusions Our findings indicate that the GRACE score has predictive value in determining whether NSTE-ACS patients would receive PCI.
文摘BACKGROUND GRACE and SYNTAX scores are important tools to assess prognosis in non-STelevation acute coronary syndrome(NSTE-ACS).However,there have been few studies on their value in patients receiving different types of therapies.AIM To explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies.METHODS The data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups.A total of 195 patients who received agents alone comprised the medication group,156 who received medical therapy combined with stents comprised the stent group,and 35 patients who were given agents and underwent coronary artery bypass grafting(CABG)comprised the CABG group.General information was compared among the three groups.GRACE and SYNTAX scores were calculated.The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events(MACEs)was analyzed.Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS.Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model.RESULTS The incidence of MACE increased with the elevation of GRACE and SYNTAX scores(all P<0.05).The incidence of MACE was 18.5%,36.5%,and 42.9%in the medication group,stent group,and CABG group,respectively.By comparison,the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups(all P<0.05).The incidence of MACE was 6.2%,28.0%and 40.0%in patients with a low GRACE score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 31.0%,30.3%and 42.9%in patients with a medium GRACE score in the medication group,stent group,and CABG group,respectively(P>0.05).The incidence of MACE was 16.9%,46.2%,and 43.8%in patients with a high GRACE score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 16.2%,35.4%and 60.0%in patients with a low SYNTAX score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 37.5%,40.9%,and 41.7%in patients with a medium SYNTAX score in the medication group,stent group,and CABG group,respectively(P>0.05).MACE incidence was 50.0%,75.0%,and 25.0%in patients with a high SYNTAX score in the medication group,stent group,and CABG group,respectively(P<0.05).Univariate Cox regression analyses showed that both GRACE score(hazard ratio[HR]=1.212,95%confidence interval[CI]:1.083 to 1.176;P<0.05)and SYNTAX score(HR=1.160,95%CI:1.104 to 1.192;P<0.05)were factors influencing MACE(all P<0.05).Multivariate Cox regression analyses showed that GRACE(HR=1.091,95%CI:1.015 to 1.037;P<0.05)and SYNTAX scores(HR=1.031,95%CI:1.076 to 1.143;P<0.05)were independent predictors of MACE(all P<0.05).CONCLUSION GRACE and SYNTAX scores are of great value for evaluating the prognosis of NSTE-ACS patients,and prevention and early intervention strategies should be used in clinical practice targeting different risk scores.
文摘【目的】评价GRACE评分对急诊科急性胸痛患者30 d心血管不良事件(MACE)的预测价值。【方法】使用前瞻性观察研究的方法纳入2016年1月1日至2016年4月1日在我院急诊科首诊急性胸痛的患者,记录患者临床基本资料,完成GRACE评分的计算,并对入组的患者进行30 d MACE的随访。【结果】入选209例患者,男性110例(52.63%),女性99例(47.37%),年龄范围20~98岁,平均年龄(65.28±16.85)岁。发生MACE 12例,其中急诊死亡2例,住院期间死亡3例,出院后死亡6例,再发心肌梗死1例。与非MACE组相比,MACE组患者年龄,BMI,住院人数,CCU住院例数、GRACE评分均高于非MACE组患者,两组比较具有统计学差异(P<0.05);GRACE评分预测急性胸痛30 d MACE的ROC曲线下面积(95%CI)为0.819(0.735-0.902),最佳敏感性为0.92,特异性为0.65。不同GRACE评分危险分层中对30 d心血管不良事件概率分别为0.95%(低危)、6.67%(中危)、18.92%(高危)。【结论】GRACE评分对急性胸痛患者30
