TIMI风险评分与GRACE风险评分对中国ST段抬高型心肌梗死患者院内死亡率的预测价值

Prognostic Value of TIMI and GRACE Risk Scores for In-hospital Mortality in Chinese Patients With ST-segment Elevation Myocardial Infarction

目的:比较心肌梗死溶栓治疗临床试验(TIMI)风险评分和全球急性冠状动脉事件注册(GRACE)风险评分对ST段抬高型心肌梗死(STEMI)患者院内死亡率的预测价值。方法:本研究全部数据均来自前瞻性、多中心大规模临床注册研究中国心肌梗死(CAMI)注册研究。在2013-01-01至2014-09-30期间,该研究共连续入选全国31个省、自治区和直辖市107家医院的STEMI患者17 886例。本研究对STEMI患者进行TIMI和GRACE两种风险评分计算,并且比较两种评分系统对STEMI患者院内死亡率的预测价值。结果:在17 886例STEMI患者中,76.5%(n=13 685)为男性;平均年龄(61.9±12.4)岁;住院天数中位值10.0天;住院死亡率为6.4%(n=1 153);4.3%(n=764)发生过院前心脏骤停;52.5%(n=9382)为前壁心肌梗死/左束支阻滞;53.4%(n=9 555)接受了再灌注治疗,再灌注治疗时间的中位值为300.0 min,其中10.0%(n=1 782)接受了溶栓治疗,43.4%(n=7 763)接受了急诊经皮冠状动脉介入治疗(PCI),仅有0.1%(n=10)接受了急诊冠状动脉旁路移植术(CABG)。用受试者工作特征(ROC)模型计算TIMI风险评分和GRACE风险评分对院内死亡率预测价值的曲线下面积(AUC)分别为0.7956(95%CI:0.7822~0.8090)和0.8096(95%CI:0.7963~0.8230)。结论:TIMI风险评分和GRACE风险评分对中国STEMI患者院内死亡率预测价值基本相当,但由于纳入变量多,评分较为复杂,妨碍了这两种评分模型在临床中的使用。

Objectives：The purpose of this study was to evaluate the prognostic value of the Thrombolysis In Myocardial Infarction（TIMI） and Global Registry of Acute Coronary Events（GRACE） risk scores for in-hospital mortality in Chinese ST-segment elevation myocardial infarction（STEMI） patients.Methods： Present data are obtained from the prospective, multicenter Chinese AMI（CAMI） registry, 107 hospitals from 31 provinces, municipalities or autonomous districts in China took part in this study. From January 2013 to September 2014, 17 886 consecutive ST-segment elevation myocardial infarction patients admitted to these 107 hospitals were enrolled. For each patient, TIMI and GRACE risk scores were calculated using specific variables collected at admission. Their prognostic value on the primaryendpoint（in-hospital mortality） was evaluated.Results： Mean age of this patient cohort was（61.9±12.4）years, 76.5%（n=13 685） patients were males. The in-hospital mortality was 6.4%（n=1 153）and the median length of hospital stay was 10.0 days. The incidence of cardiac arrest at admission were 4.3%（n=764）. Coronary reperfusion therapy including fibrinolytic therapy（n=1 782）, primary percutaneous coronary intervention（n=7 763） and emergent coronary artery bypass grafting（n=10） were applied to 9 555（53.4%） patients and the median of time to reperfusion was 300.0 minutes. The predictive accuracy of TIMI and GRACE for in-hospital mortality was similar： TIMI risk score（AUC） [area under the curve： 0.7956; 95% confidence interval（95%CI： 0.7822-0.8090）] and GRACE risk score（AUC： 0.8096; 95%CI： 0.7963-0.8230）. Conclusions： The TIMI and GRACE risk score demonstrate similar predictive accuracy for in-hospital mortality and there are some disadvantages in risk stratification by these two risk scores for Chinese STEMI patients.