三种评分系统对老年经皮冠状动脉介入治疗患者主要不良心脑血管事件的预测

Prediction of major adverse cardiovascular and cerebrovascular events in elderly patients undergoing percutaneous coronary intervention with three scoring systems

目的评价欧洲心脏手术风险评估系统(EuroSCOREII)、美国国家心血管注册数据库风险评分体系(NCDRCathPCI风险评分体系)和年龄、肌酐以及左心室射血分数(ACEF)评分对经皮冠状动脉介入治疗(PCI)后患者院内主要不良心脑血管事件(MACCE)的预测价值。方法回顾性分析404例连续入院的老年PCI术后患者的评分及早期预后的情况,评分系统的预测校准度采用Hosmer-Lemeshow(H-L)拟合优度检验,预测鉴别度采用受试者工作特征(ROC)曲线评价。结果MACCE发生17例(4.21%)。EuroSCOREII、NCDRCathPCI、ACEF预测老年患者PCI术后MACCE的ROC曲线下面积分别为0.871、0.785和0.744(P<0.01),两两比较,EuroSCOREII和ACEF差异有统计学意义(P<0.05)。EuroSCOREII和NCDRCathPCI评分系统预测MACCE校准度良好(EuroSCOREII:5.14例,95%CI4.63~5.70;NCDRCathPCI:4.71例,95%CI4.47~4.97);而ACEF评分系统高估了MACCE的例数(ACEF:49.41例,95%CI19.57~124.97)。结论对于老年PCI术后的患者,3种评分都可以较好地预测术后院内MACCE的发生,EuroSCOREII的预测价值更好。

Objective To evaluate the European Heart Surgery Risk Assessment System(EuroSCORE II),the US National Cardiovascular Registry Database Risk Score System(NCDRCathPCI Risk Score System),and the age,creatinine,and left ventricular ejection fraction(ACEF)score for major adverse cardiovascular and cerebrovascular events(MACCE)in patients after percutaneous coronary intervention(PCI).Methods A retrospective analysis of 404 consecutive patients with postoperative PCI patients scored and early prognosis.Calibration was assessed by the Hosmer-Lemeshow(H-L)test,and discrimination was assessed by the receiver operating characteristic(ROC)curve.Results There were 17 cases(4.21%)of MACCE.EuroSCORE II,NCDRCathPCI,and ACEF predicted the area under the ROC curve of elderly patients with PCI after surgery were 0.871,0.785,and 0.744,respectively(P<0.01);the difference between EuroSCORE II and ACEF was statistically significant(P<0.05).The EuroSCORE II and NCDRCathPCI scoring systems predict good MACCE calibration(EuroSCORE II:5.14,95% CI 4.63-5.70;NCDRCathPCI:4.71,95% CI 4.47-4.97);and the ACEF scoring system underestimates MACCE.The number of cases(ACEF:49.41 cases,95% CI 19.57-124.97).Conclusions For the elderly patients with postoperative PCI,all three scores can better predict the occurrence of postoperative in-hospital MACCE,and the predictive value of EuroSCORE II is better.