HEART评分对急诊胸痛患者心血管不良事件的预测价值

Predictive value of HEART scores for cardiovascular adverse events in the patients with emergency chest pain

目的评估HEART评分在急诊非ST段抬高心源性胸痛患者心血管事件发生的预测价值。方法选择2015年10月~2016年12月在我院收治的急诊非ST段抬高的心源性胸痛患者,分为急性冠脉综合征组(acute coronary syndrome,ACS)和心绞痛组,比较两组HEART评分,并随访治疗30 d后心血管不良事件发生情况。结果本研究纳入97例患者,ACS组60例,平均年龄(62.25±7.21)岁,HEART危险程度评分为(7.55±0.89)分;心绞痛组37例,平均年龄(70.03±10.59)岁,HEART危险程度评分为(5.22±1.27)分。ACS组的HEART评分显著高于心绞痛组,差异有统计学意义(P<0.05)。30 d随访发生心血管不良事件概率为21.6%,HEART评分6时对30 d心血管不良事件的发生有良好的预测价值,ROC曲线下面积为0.922(95%CI 0.868~0.977),不同HEART评分危险分层30 d心血管不良事件概率分别为0~3分(1.0%)、4~6分(5.15%)、7~10分(16.5%)。结论 EART评分能够有效、简单、快速、准确评估非ST段抬高急诊胸痛患者的心血管事件发生风险,对急诊科快速病情评估和诊治过程起到非常重要的作用。

Objective To evaluate the predictive value of HEART scores in the occurrence of cardiovascular events in the patients with non-ST elevation cardiogenic chest pain in emergency department. Methods Patients with non-ST elevation cardiogenic chest pain who were admitted to the emergency department in our hospital from October 2015 to December 2016 were divided into acute coronary syndrome （ACS） group and angina group. The HEART scores were compared between the two groups, and occurrence of cardiovascular adverse events were followed-up 30 days after treatment. Results 97 patients were included in this study. 60 patients were in the ACS group, with an average age of （62.25±7.21）years old. HEART risk score was（7.55±0.89）points; there were 37 cases in the angina group, with an average age of （70.03±10.59） years old. HEART risk score was（5.22±1.27）points. The HEART score in ACS group was significantly higher than that in angina group, and the difference was statistically significant（P〈0.05）. The probability of cardiovascular adverse events was 21.6% at the 30-day follow-up visit. When the HEART score was 6, there was a good predictive value for the occurrence of 30-day cardiovascular adverse events. The area under the ROC curve was 0.922（95% CI 0.868±0.977）. The probabilities of 30-day cardiovascular adverse events at different HEART scores of risk stratification were 0-3 points（ 1.0% ）, 4-6 points （5.15%）, and 7-10 points （16.5%）. Conclusion HEART scores can effectively, simply, quickly and accurately assess the risk of cardiovascular events in non-ST elevation patients with chest pain, which plays a very important role in the rapid disease assessment and diagnosis and treatment process in the emergency department.