GRACE评分对75岁以上急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗预后的分析

发布时间：2018-05-18 09:32

本文选题：心肌梗死 + 老年人　；参考：《中国循环杂志》2017年12期

【摘要】：目的:探讨全球急性冠状动脉事件注册(GRACE)评分系统对75岁以上急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)短期临床获益的价值。方法:连续收集我院2011-11至2014-01之间,104例75岁以上以急性心肌梗死并行直接PCI治疗的患者,根据患者入院时GRACE评分系统将患者分为低中危组72例[GRACE评分112~154(136.5±10.6)分],高危组32例[GRACE评分155~202(167.8±12.3)分],比较两组间基线差异及结局,主要结局是1年全因死亡率。通过受试者工作特征(ROC)曲线评价GRACE评分系统预测1年死亡率的价值。生存曲线log-rank检验、单因素COX回归模型分析低中危组和高危组与结局的相关性。结果:GRACE评分系统预测1年死亡的ROC检验曲线下面积0.788,敏感性70.0%,特异性84.0%。单因素COX回归分析显示GRACE评分高危组1年死亡风险明显高于低中危组(HR=5.75,95%CI:1.486~22.256,P=0.0113)。生存曲线分析示GRACE评分高危组1年死亡率明显高于低中危组(21.9%vs 4.2%,log-rank检验P=0.0039)。结论:针对老年急性STEMI患者,GRACE评分系统可以进一步区分低中危和高危人群并具有预测1年临床预后的作用。
[Abstract]:Objective: to evaluate the value of global acute coronary event registration (GRACEE) scoring system in the short-term clinical benefits of direct percutaneous coronary intervention (PCI) in patients over 75 years old with acute ST-segment elevation myocardial infarction (STEMI). Methods: 104 patients aged over 75 years with acute myocardial infarction treated with direct PCI were collected from 2011-11 to 2014-01 in our hospital. According to the GRACE scoring system on admission, the patients were divided into two groups: 72 patients with low and moderate risk [GRACE score 112154146.5 卤10.6], and 32 patients with high risk (GRACE score 155202020 167.8 卤12.3). The baseline difference and outcome between the two groups were compared. The main outcome was 1 year total cause mortality. The value of GRACE scoring system in predicting 1-year mortality was evaluated by ROC- curve. Survival curve log-rank test and univariate COX regression model were used to analyze the correlation between low and middle risk group and high risk group. Results the area under the ROC test curve was 0.788, the sensitivity was 70.0and the specificity was 84.0. Univariate COX regression analysis showed that the 1 year risk of death in the high risk group with GRACE score was significantly higher than that in the low and moderate risk group. Survival curve analysis showed that the 1-year mortality rate in the high risk group with GRACE score was significantly higher than that in the low and middle risk group (21.9 vs 4.2). Conclusion: the Grace scoring system for elderly patients with acute STEMI can further distinguish the low, middle and high risk population and predict the clinical prognosis for 1 year.
【作者单位】：中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科;首都医科大学附属北京友谊医院急诊科;
【基金】：科学化精细化多学科综合诊疗体系建立(2014-GWH03)
【分类号】：R542.22

【相似文献】