GRACE与TIMI评分对非ST段抬高急性冠脉综合征住院心性死亡风险预测的比较

COMPARISON OF THE PROGNOSTIC VALUE BETWEEN GRACE AND TIMI SCORES SYSTEM IN THE IN-HOSPITAL CARDIAC DEATH IN PATIENTS WITH NON-ST ELEVATED ACUTE CORONARY SYNDROMES

目的：探讨全球急性冠状动脉事件注册（GRACE）评分与心肌梗死溶栓治疗（TIMI）评分对非ST段抬高急性冠脉综合征（NSTEACS）患者住院期间发生心性死亡的预测价值.方法：查阅2008年1月至2012年12月在我院住院期间发生心性死亡且接受过冠脉造影的NSTEACS患者16例为死亡组.同期抽取未发生心性死亡的NSTEACS患者175例为生存组.分别计算每位患者的GRACE评分与TIMI评分.分别描绘两种评分的ROC曲线并计算曲线下面积（AUC）,以及采用非参数检验对曲线下面积进行比较.结果：GRACE评分预测住院期间心性死亡的准确度为AUC=0.864,95％CI：0.763～0.933,TI-MI评分预测住院期间心性死亡的准确度为AUC=0.717,95％ CI：0.598～0.817.两评分曲线下面积比较,差异有统计学意义（P＜0.05）,GRACE评分曲线下面积大于TIMI评分,GRACE评分较TIMI评分的预测价值更高.结论：GRACE评分和TIMI评分对NSTEACS患者住院期间发生心性死亡均有较好的预测价值,GRACE评分的预测价值优于TIMI评分.

Objective：To compare GRACE and TIMI scores in the evaluation of prognosis of in-hospital cardiac death in patients with non-ST elevated acute coronary syndromes （NSTEACS）.Methods：The patients with NSTEACS were enrolled in the study who were admitted to hospitals consecutively from Jan.2008 to Dec.2012.There were 16 NSTEACS patients with in-hospital cardiac deaths and known coronary artery disease （CAD,prior stenosis ≥ 50%） or stenosis ≥ 50% of in-hospital coronary arteriography.Survival group consisted of 175 random contemporary NSTEACS patients with known CAD （prior stenosis ≥ 50%） or stenosis ≥50% of in-hospital coronary arteriography.The TIMIand GRACE scores were calculated according to the baseline characteristics on admission.The predictive value of the model was assessed with evaluation of the area under curve （AUC） in receiver-operating characteristic analysis.C-statistics were calculated to compare the discriminative capacities of different scores for in-hospital cardiac death.The areas under correlated ROC curves were compared by a nonparametric approach.Results：For in-hospital cardiac death,the AUC （0.864） of GRACE score was more than the AUC （0.717） of TIMI score,so GRACE score displayed significantly better discrimination than the TIMI score （P 〈0.001,both comparisons）.Conclusion：Both GRACE and TIMI scores display high predictive value,GRACE score is superior.