非ST段抬高急性冠状动脉综合征心肌梗死溶栓试验危险评分的临床验证

Validation of the TIMI risk score in patients with acute coronary syndromes without ST elevation

目的评价TIMI危险评分系统对非ST段抬高急性冠状动脉综合征(ACS)非选择病例的有效性。方法将以"非ST段抬高ACS"入院的1298例患者在入院后24h内,根据TIMI危险评分系统,分为TIMI0～2分组(534例)、TIMI3～4分组(632例)、TIMI5～7分组(132例)。观察2周有无心肌梗死、心脏性死亡发生。结果随着TIMI危险评分的增加,患者心脏事件的发生率和心脏性死亡发生率也随之升高,分别为TIMI0～2分组1.7%和0.6%;TIMI3～4分组6.2%和2.8%;TIMI5～7分组12.9%和8.3%,差异有统计学意义(P<0.01)。结论TIMI危险评分能准确、量化地评估非ST段抬高ACS的危险。

Objective To validate the effectiveness of the TIMI risk score in unselected patients with acute coronary syndromes （ACS） without ST elevation. Methods From July 2003 to May 2007,1298 consecutive patients with non-ST elevation ACS were examined. The risk score was calculated as the sum of seven presenting characteristics （age ≥65 years, ≥3 cardiac risk factors, documented coronary disease, recent severe angina, ST deviation ≥0. 05 mV, elevated cardiac markers, prior aspirin use）. The effects of the TIMI risk score on combined cardiac events during hospital stay were analyzed. Results In the 1298 consecutive patients, more patients （41. 1%） with low risk scores （0 to 2） and less patients （10.2%） with high risk scores （5 to 7） were en- rolled than in TIMI liB, ESSENCE and PRISM-PLUS trials. With increasing the TIMI risk score,the risk for death or myocardial infarction at 2 weeks increased, ranging from 1. 7% in group with scores 0-2,6.2% in group with scores 3-4 to 12.9% in group with scores 5-7（ P 〈0.01）. The complexity of clinical characteristics and coronary angiographic findings increased significantly with the rise in TIMI risk score （ P 〈0.01）. Conclusion In unselected patients with non-ST elevation ACS, the TIMI risk score is a simple and effective prognostication scheme that categorizes a patient＇s risk of death and ischemic events and provides a basis for therapeutic decision making.