| 摘要: |
| 目的 探讨心肌梗死溶栓（TIMI）和全球急性冠状动脉事件注册（GRACE）评分系统对中国非ST段抬高型心肌梗死（NSTEMI）患者院内事件的评估价值。方法 连续纳入2017年1月1日至12月1日在上海交通大学医学院附属仁济医院心血管内科住院治疗的NSTEMI患者。终点事件为院内死亡、再梗死、心力衰竭、心源性休克和心搏骤停。患者入院时根据TIMI和GRACE评分结果进行危险分层评分，采用ROC曲线评估2种评分系统及两者结合对院内事件的预测价值。使用TIMI评分筛选所有人群，再将TIMI评分中危患者进一步分为GRACE评分高危亚组（GRACE评分≥140分）和GRACE评分非高危亚组（GRACE评分<140分），比较两个亚组患者院内事件发生情况。结果 本研究共纳入232例患者，其中男163例、女69例，平均年龄为66.1（95% CI 64.6~67.6）岁。TIMI评分低危、中危、高危患者分别为69例（29.7%）、142例（61.2%）和21例（9.1%），3组院内事件发生率分别为14.5%（10/69）、24.6%（35/142）和33.3%（7/21）；GRACE评分低危、中危、高危患者分别为41例（17.7%）、85例（36.6%）和106例（45.7%），3组院内事件发生率分别为7.3%（3/41）、11.8%（10/85）和36.8%（39/106）。GRACE评分和TIMI评分对是否发生院内事件均显示出较好的区分度，GRACE评分对院内事件的预测价值更高（AUC 0.81 vs 0.62，P<0.001）。TIMI评分中危组患者中，GRACE评分高危亚组的院内事件发生率高于GRACE评分非高危亚组[38.2%（29/76）vs 9.1%（6/66），OR=6.2，95% CI 2.4~16.1，P<0.001]。TIMI评分与GRACE评分结合对院内事件具有良好的预测价值（AUC=0.71，95% CI 0.65~0.77），并且其阳性预测值（37.1%）高于TIMI评分（33.3%）和GRACE评分（36.8%）。结论 在中国NSTEMI患者中，GRACE评分的预测准确性优于TIMI评分，但简便性不足。TIMI评分与GRACE评分结合应用的危险分层方法为预测中国NSTEMI患者的院内事件提供了一种简便且有效的判别工具。 |
| 关键词: 非ST段抬高型心肌梗死 中国 风险评分 院内事件 冠状动脉狭窄 |
| DOI：10.16781/j.0258-879x.2020.09.1005 |
| 投稿时间：2020-08-15修订日期：2020-09-11 |
| 基金项目:国家自然科学基金（81900308），上海交通大学医学院高原高峰项目（dly201512）． |
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| Value of TIMI and GRACE score systems in predicting in-hospital events in Chinese patients with non-ST-segment elevation myocardial infarction |
| SHEN Lan1,2△,LU Yan-qiao1△,WANG Li3,MIAO Yu-tong1,SHEN Ling-hong1,HE Ben1* |
(1. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China;
2. Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
3. Department of Geriatrics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To evaluate the clinical value of thrombolysis in myocardial infarction (TIMI) and global registry of acute coronary events (GRACE) score systems in predicting the risk of in-hospital events in Chinese patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods Patients with NSTEMI admitted to the Department of Cardiovasology, Renji Hospital, Shanghai Jiao Tong University School of Medicine between Jan. 1 to Dec. 1, 2017 were consecutively enrolled. The end-point events were in-hospital mortality, reinfarction, heart failure, cardiac skock, and sudden cardiac arrest. Patients were scored by TIMI and GRACE score systems on hospital admission, and receiver operating characteristic (ROC) curve was used to evaluate the value of the two score systems and the combination of both in predicting in-hospital events. TIMI score was used to screen all the patients, and the TIMI medium-risk patients were further divided into GRACE high-risk subgroup (GRACE score≥140) and GRACE non-high-risk subgroup (GRACE score<140). The incidence of in-hospital events was compared between the two subgroups. Results A total of 232 patients were included in this study (163 males and 69 females, with an average age 66.1 years and 95% confidence interval [CI] 64.6-67.6 years). TIMI score grouped 69 (29.7%), 142 (61.2%) and 21 (9.1%) patients into low-, medium- and high-risk, and the incidence rates of in-hospital events were 14.5% (10/69), 24.6% (35/142) and 33.3% (7/21), respectively. GRACE score grouped 41 (17.7%), 85 (36.6%) and 106 (45.7%) paitents into low-, medium- and high-risk, and the incidence rates of in-hospital events were 7.3% (3/41), 11.8% (10/85) and 36.8% (39/106), respectively. GRACE score and TIMI score both demonstrated good discrimination and GRACE performed better for in-hospital events (area under curve [AUC] 0.81 vs 0.62, P<0.001). Further subgrouping the TIMI medium-risk group, we found that GRACE high-risk subgroup had significantly higher incidence rate of in-hospital events than the GRACE non-high-risk subgroup (38.2% [29/76] vs 9.1% [6/66], odds ratio 6.2, 95% CI 2.4-16.1, P<0.001). Combination of TIMI and GRACE scores improved the predictive value of in-hospital events (AUC=0.71, 95% CI 0.65-0.77), with a favorable higher positive predictive value than that of TIMI or GRACE score alone (37.1% vs 33.3% and 36.8%). Conclusion GRACE score has better predictive accuracy than TIMI score in Chinese NSTEMI patients, but sacrifices simplicity. The combination of GRACE and TIMI scores is an easy and effective discriminative tool in predicting in-hospital events in Chinese NSTEMI patients. |
| Key words: non-ST-segment elevation myocardial infarction China risk score in-hospital events coronary stenosis |
