TIMI、PURSUIT和GRACE评分对急诊非ST段抬高急性冠脉综合征患者风险预测的比较

Comparison of TIMI, PURSUIT and GRACE risk scores in patients presenting emergency department with non-ST-elevation acute coronary syndrome

目的探讨NSTE-ACS评分GRACE、PURSUIT和TIMI在急诊非ST段抬高急性冠脉综合征(NSTE-ACS)患者风险预测上的价值。方法在PubMed上检索TIMI、PURSUIT和GRACE风险评分对NSTE-ACS患者风险预测的研究。比较不同评分对患者院内、短期(30-day)、长期(360-day)的心血管事件的预测效果。运用χ2检验和威尔克森统计值进行统计分析。结果共有8个研究符合检索条件,共计25 247例NSTE-ACS患者被正式评估。依据TIMI、PURSUIT和GRACE评分患者被相对地划分为低危组、中危组和高危组。院内心血管事件发生率在各评分、各组别间差异无统计学意义(P>0.05)。30 d内的主要心血管风险预测,对于低、中危组患者,TIMI评分优于GRACE和PURSUIT(P<0.05);但对于高危组患者,PURSUIT评分预测效果较好(P<0.05)。1年内主要心血管风险预测,低危组内各评分未见统计学差异(P>0.05),TIMI和PURSUIT评分对中危组患者的风险预测优于GRACE(P<0.05);对于高危组,PURSUIT和GRACE的风险预测效果优于TIMI(P<0.05)。结论 TIMI风险评分适用于NSTE-ACS患者的院内、短期和长期心血管事件的预测,但对于30 d内主要心血管事件风险的预测PURSUIT评分优于TIMI和GRACE。高危组1年内主要心血管事件风险的预测,GRACE评分优于PURSUIT和TIMI。

Objective Risk stratification for patients with non-ST-elevation acute coronary syndrome （NSTE-ACS） is a difficult challenge for physicians. This study was to compare the prognostic value of three clinical risk scores, the GRACE, PURSUIT and TIMI in NSTE-ACS patients. Methods PubMed was systematically searched for the TIMI, PURSUIT and GRACE risk score studies, especially the UA/NSTEMI studies. 8 eligible studies with 25 247 people were formally appraised. The GRACE scores, PURSUIT scores and TIMI scores were subsequently divided into low, intermediate and high equivalent strata to facilitate comparison. The study endpoint was cardiac event in hospital, at short term （30-days） and over longer term （1-year） follow-up. Chi-square test and Wilcoxon （Gehan） Statistics were used for statistical analysis where appropriate. Results In- hospital cardiac event rates in all risk scores showed no statistically significant difference （P〉0.05）. At 30-days follow-up, in low and intermediate risk group, TIMI performs better than the other two risk scores（P〈0.05 ） ; but in the high risk group, PURSUIT performs best（P〈0.05 ）. At 1-year follow-up, there is no statistical significance among each low risk group（P〉0.05 ） ; TIMI and PURSUIT performs better in the intermediate group（P〈0.05）, but in the high risk group, PURSUIT and GRACE perform better （P〈0.05）. Conclusion In NSTE-ACS population, TIMI risk score can be widely applied in prognosis of cardiac events at in- hospital, short term and long term. At 30-days PURSUIT is better than others in the high-risk group for evaluation of prognosis, while GRACE is superior at long term follow-up in high risk group.