HEART和HEARTS3评分体系对非ST段抬高胸痛患者心血管事件风险的评估价值对比

Value of HEART and HEARTS3 scoring system in evaluating cardiovascular event risk in patients with non ST segment elevation chest pain

目的对比HEART和HEARTS3评分体系对非ST段抬高胸痛患者心血管事件风险的评估作用,探讨其临床应用价值。方法以徐州市中心医院2012年8月至2015年8月收治的351例非ST段抬高胸痛患者为研究对象,进行回顾性分析。记录患者发病后30 d内心血管事件(急性冠脉综合征)发生情况,并分别应用HEART、HEARTS3评分体系评价其危险分层,运用受试者工作特征(receiver operator characteristic,ROC)曲线及曲线下面积(AUC)计算两种评分体系评估患者预后的灵敏度、特异性,并比较。结果治疗30 d后共有42例患者发生急性冠脉综合征,发生率为11.97%,其中急性心肌梗死26例,不稳定型心绞痛16例。发生组年龄及糖尿病、原发性高血压(高血压)、吸烟、高脂血症、冠状动脉粥样硬化性心脏病(冠心病)家族史、心肌梗死史、经皮冠状动脉介入(PCI)治疗史、冠状动脉疾病史患者比例均高于未发生组,差异有统计学意义(P<0.05)。HEART评分体系高危者,其预测急性冠脉综合征、急性心肌梗死的准确率分别为70.37%、44.44%,均低于HEARTS3评分的83.78%%、67.57%,差异有统计学意义(P<0.05)。HEART预测治疗30 d后急性冠脉综合征、急性心肌梗死的灵敏度、特异性、曲线下面积均低于HEARTS3评分体系,差异有统计学意义(P<0.05)。结论 HEART和HEARTS3评分体系均可有效评估非ST段抬高胸痛患者心血管事件发生风险,HEARTS3评分准确性更高,对胸痛患者疾病的快速诊断及预后判断具有更高的价值。

Objectives To compare the effect of HEART and HEARTS3 scoring system on evaluating cardiovascular events in patients with non ST segment elevation chest pain ,and to explore its clinical application value. Methods Clinical data of 351 patients with non ST segment elevation chest pain admitted in Xuzhou Central Hospital from August 2012 to August 2015 were retrospectively analyzed. Cardiovascular events （acute coronary syndrome） within 30 days were recorded. The risk stratification was assessed by HEART and HEARTS3 scoring systems. The sensitivity and specificity between the two scoring systems were evaluated by receiver operating characteristic curve （ROC）. Results After 30 days treatment ,there were 42 patients with acute coronary syndrome ,and the incidence was 11.97%. There were 26 patients with acute myocardial infarction and 16 patients with unstable angina pectoris. Age and proportions of diabetes,hypertension,smoking,hyperlipidemia,coronary heart disease family history,history of myocardial infarction, percutaneous coronary intervention（PCI）therapy,history of coronary artery disease（CAD）in occurrence group were higher than those in non-occurrence group ,the differences were statistically significant（P〈0.05）. Accuracy rates of prediction of acute coronary syndrome and acute myocardial infarction of patients with high HEART scores were 70.37%and 44.44%,which were lower than those of patients with high HEARTS3 scores of 83.78% and 67.57%,the differences were statistically significant （P〈0.05）. Sensitivity,specificity,and area under ROC （AUC） of prediction acute coronary syndrome and acute myocardial infarction by HEART scoring system were lower than those by HEARTS 3 system,the differences were statistically significant（P〈0.05）. Conclusions Both of HEART and HEARTS3 scoring systems can be used to evaluate the risk of cardiovascular event in patients with non ST segment elevation chest pain , but HEARTS3 is more accurate and has higher value in the diagnosis and prognosis of patients with chest pain.