CHA2DS2-VASc评分与全球急性冠状动脉事件注册风险评分对心房颤动患者经皮冠状动脉介入治疗后不良预后的预测价值

Values of CHA2DS2-VASc score and Global Registry of Acute Coronary Events risk score in predicting poor prognosis of patients with atrial fibrillation after percutaneous coronary intervention

  • 摘要:
    目的 探讨CHA2DS2-VASc评分与全球急性冠状动脉事件注册(GRACE)风险评分对心房颤动(简称房颤)患者经皮冠状动脉介入治疗(PCI)术后不良预后的预测价值。
    方法 选取确诊房颤并接受PCI术治疗的180例患者作为研究对象,入院后评估CHA2DS2-VASc评分和GRACE风险评分。术后随访12个月,主要结局指标为主要不良心脏事件(MACE), 次要结局指标为全因死亡率。依照是否发生MACE和是否死亡分别将患者分组,并比较各亚组患者临床资料的差异。通过Cox比例风险模型评估CHA2DS2-VASc评分和GRACE风险评分对结局指标的预测价值。绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)等,评估CHA2DS2-VASc评分和GRACE风险评分对结局指标的预测效能。
    结果 21例(11.7%)患者发生MACE(MACE组),159例患者未发生MACE(非MACE组); MACE组患者年龄、充血性心力衰竭发生率、CHA2DS2-VASc评分和GRACE风险评分均高于非MACE组患者,差异有统计学意义(P < 0.05)。10例(5.6%)患者死亡(死亡组), 170例患者存活(存活组); 死亡组患者年龄、CHA2DS2-VASc评分和GRACE风险评分均高于存活组患者,差异有统计学意义(P < 0.05)。Cox比例风险模型分析显示, CHA2DS2-VASc评分、GRACE风险评分升高均与MACE发生风险增加相关(HR=2.056、1.076, 95%CI: 1.558~2.713、1.048~1.104, P < 0.001), 且CHA2DS2-VASc评分、GRACE风险评分升高均与全因死亡率增高相关(HR=2.949、1.114, 95%CI: 1.983~4.387、1.067~1.163, P < 0.001)。ROC曲线显示, CHA2DS2-VASc评分联合GRACE风险评分预测MACE、全因死亡率的AUC分别为0.856、0.943, 敏感度分别为85.7%、80.0%, 特异度分别为73.0%、90.6%。
    结论 CHA2DS2-VASc评分、GRACE风险评分升高均与房颤患者PCI术后MACE发生风险增加和全因死亡率增高相关,两者联合应用对房颤患者PCI术后MACE、全因死亡率均具有较高的预测价值。

     

    Abstract:
    Objective To investigate the values of CHA2DS2-VASc score and the Global Registry of Acute Coronary Events (GRACE) risk score in predicting the poor prognosis of patients with atrial fibrillation after percutaneous coronary intervention (PCI).
    Methods A total of 180 patients diagnosed as atrial fibrillation and treated with PCI were selected as research objects, and CHA2DS2-VASc score and GRACE risk score were evaluated after hospital admission. Patients were followed up for 12 months, with the major adverse cardiac events (MACE) as the primary outcome index and all-cause mortality as the secondary outcome index. The patients were divided into different subgroups according to the occurrence of MACE and death, and the general materials were compared between subgroups. Cox proportional hazard model was used to evaluate the values of CHA2DS2-VASc score and GRACE risk score in predicting outcome indexes. The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated, and the predictive efficiencies of CHA2DS2-VASc score and GRACE risk score for outcome indexes were evaluated.
    Results A total of 21 patients (11.7%) with MACE were enrolled in the MACE group, and 159 patients without MACE were enrolled in the non-MACE group; the age, incidence of congestive heart failure, CHA2DS2-VASc score and GRACE risk score in the MACE group were significantly higher than those in the non-MACE group (P < 0.05). A total of 10 dead patients (5.6%) were enrolled in the death group, and the 170 survival patients were enrolled in the survival group; the age, CHA2DS2-VASc score and GRACE risk score in the death group were significantly higher than those in the survival group (P < 0.05). Cox proportional hazard model showed that the increases of CHA2DS2-VASc score and GRACE risk score were related to the increase of risk of MACE (HR=2.056, 1.076; 95%CI, 1.558 to 2.713, 1.048 to 1.104; P < 0.001), and the increases of CHA2DS2-VASc score and GRACE risk score were also significantly associated with the increase of all-cause mortality (HR=2.949, 1.114; 95%CI, 1.983 to 4.387, 1.067 to 1.163; P < 0.001). ROC curve showed that the AUC values of CHA2DS2-VASc score combined with GRACE risk score in predicting MACE and all-cause mortality were 0.856 and 0.943 respectively, the sensitivity values were 85.7% and 80.0% respectively, and specificity values were 73.0% and 90.6% respectively.
    Conclusion Increase of CHA2DS2-VASc score and GRACE risk score is associated with increase of risks of MACE and all-cause mortality in patients with atrial fibrillation after PCI, and the combination of the two scoring methods has high predictive values for MACE and all-cause mortality in patients with atrial fibrillation after PCI.

     

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