GRACE评分对急诊胸痛患者30d和6个月主要不良心血管事件的预测价值

The predictive value of GRACE score for 30 - day and 6 - month major adverse cardiovascular events in Emergency Departments patients with acute chest pain

目的探讨GRACE评分对急诊室胸痛患者30d和6个月主要不良心血管事件（MACE）的预测价值。方法前瞻性队列临床观察研究方法对2012—03—17—2013—08—14在我院急诊因急性胸痛首诊的、年龄≥18岁患者进行观察。记录患者临床资料、GRACE评分、30d和6个月MACE情况。结果纳入研究的493例急性胸痛患者，30d和6个月随访中，分别有32例（6％）和38例（7％）发生MACE。Logistic回归分析数据可见，GRACE评分、性别、吸烟史对急性胸痛患者30d和6个月的MACE发生有预测意义。GRACE评分预测胸痛患者30dMACE发生的曲线下面积（areaundercurve，AUC）为0．815（95％C10．778—0．849），Cutoff值为174分，而预测胸痛患者6个月死亡的AUC为0．807（95％C10．769～0．841），Cutoff值为173分。结论GRACE评分可以有效预测急诊急性胸痛患者30d和6个月是否发生MACE。

Objective To explore the predictive value of GRACE scores to the risk of 30 - day and 6 - month major adverse cardiovascular events （MACE） in chest pain patients presented to Emergency Department （ED）. Methods A perspective cohort study was conducted in ED from March 17, 2012 to August 14, 2013. Chest pain patients presented to ED with age over 18 years old were enrolled. Clinical data and items of GRACE risk scores were recorded. The 30 - day and 6 - month MACE of patients was followed up through Health Insurance Infornmtion Management System and phone. Results A total of 493 acute chest pain patients were enrolled. Thirty two patients （6%） and 38 cases （7%） happened MACE within 30 days and 6 month. The Logistic regression analysis of this research showed that GRACE score, Gender and smoke were predictors of 30 - day and 6 - month MACE in patients with acute chest pain. The areas under the curve （AUC） for 30 -day MACE of GRACE score was 0.815 （95% CI 0.778 -0. 849） in cutoff with 174 points. The AUC of 6 -month GRACE score was 0. 807 （95% CI 0.769 - 0. 841 ） in cutoff with 173 points. Conclusion GRACE scoring system can predict the 30 - day and 6 - month MACE in chest pain patients presented to ED.