GRACE评分对急性胸痛患者30 d心血管不良事件的预测价值

Effect of GRACE Scores on Prediction of 30-day Cardiovascular Adverse Events in Patients with Acute Chest Pain

【目的】评价GRACE评分对急诊科急性胸痛患者30 d心血管不良事件(MACE)的预测价值。【方法】使用前瞻性观察研究的方法纳入2016年1月1日至2016年4月1日在我院急诊科首诊急性胸痛的患者,记录患者临床基本资料,完成GRACE评分的计算,并对入组的患者进行30 d MACE的随访。【结果】入选209例患者,男性110例(52.63%),女性99例(47.37%),年龄范围20~98岁,平均年龄(65.28±16.85)岁。发生MACE 12例,其中急诊死亡2例,住院期间死亡3例,出院后死亡6例,再发心肌梗死1例。与非MACE组相比,MACE组患者年龄,BMI,住院人数,CCU住院例数、GRACE评分均高于非MACE组患者,两组比较具有统计学差异(P<0.05);GRACE评分预测急性胸痛30 d MACE的ROC曲线下面积(95%CI)为0.819(0.735-0.902),最佳敏感性为0.92,特异性为0.65。不同GRACE评分危险分层中对30 d心血管不良事件概率分别为0.95%(低危)、6.67%(中危)、18.92%(高危)。【结论】GRACE评分对急性胸痛患者30

【Objective】To investigate the effect of GRACE scores on prediction of 30-day cardiovascular adverseevents in acute chest pain patients.【Methods】A prospective,observational analysis was conducted in the patients withacute chest pain in Emergency Department(ED)from January 1,2016 through April 1,2016. Data including characteris-tics and GRACE scores were collected. All causes leading to MACE were followed up at 30 th day after the onset of acutechest pain.【Results】Among a total of 209 patients presenting with acute chest pain enrolled in this study,110 were male(52.63%)and 99 were female(47.37%). The range of age was 20-98 years old,and mean age was(65.28±16.85)yearsold. During follow-up period,12 patients had MACE,2 patients died in ED,3 patients died in hospital,6 patients diedout of hospital,and 1 person was diagnosed with myocardial infarction. When compared with non-MACE group,factorsincluding age,BMI,hospitalized patient number,and number of patients admitted in CCU as well as GRACE scores,were significantly higher in MACE group(P<0.05). The predictive ROC curve area of GRACE scores in 30-day MACEwas 0.819(0.735 to 0.902). The optimal sensitivity and specificity were 0.92 and 0.65,respectively. The probability of30-day cardiovascular adverse events in various GRACE score risk stratification was 0.95%(low-risk),6.67%(medi-um-risk),and 18.92%(high-risk),respectively.【Conclusion】The GRACE score was a useful predictor to the occur-rence of 30-day cardiovascular adverse events in acute chest pain patients.