CHA2DS2-VASc评分对ST段抬高性心肌梗死急诊介入危险分层的价值

Value of CHA2DS2-VASc score in risk stratification of emergency intervention in patients with ST-segment elevation myocardial infarction

目的探讨利用CHA2DS2-VASc评分对接受急诊介入治疗的ST段抬高性心肌梗死患者危险分层的价值。方法取2017年10月—2019年10月就诊于郑州大学人民医院并接受急诊经皮冠状动脉介入治疗的ST段抬高性心肌梗死患者(425例)作为研究对象,利用CHA2DS2-VASc评分进行分组(组1:1-2分、组2:3-4分、组3:>4分),探讨其急诊介入手术情况及随评分不同院内主要不良心血管事件发生情况,利用ROC曲线验证有效性。结果三组患者急诊介入情况对比:多支病变患者占比对比:组1(29.37%)低于组2(45.95%),差异有统计学意义(P<0.05);组2(45.95%)低于组3(62.22%),差异无统计学意义(P>0.05);组1(29.37%)低于组3(62.22%),差异有统计学意义(P<0.05;门囊时间对比:组1[90(84,107)]低于组2[105(90,118)],差异有统计学意义(P<0.05);组2[105(90,118)]低于组3[108(102,119)],差异有统计学意义(P<0.05);不同CHA2DS2-VASc评分患者院内主要不良心血管事件比例不同,差异有统计学意义(P<0.001);ROC曲线示曲线下面积为:0.73,95%置信区间为:(0.68,0.78),最佳截断值为3.5。结论临床工作中,可以利用CHA2DS2-VASc评分对接受急诊介入治疗的ST段抬高性心肌梗死患者进行快速危险分层;随着评分的增加,院内主要不良心血管事件呈上升趋势。

Objective To explore the value of CHA2DS2-VASc score in risk stratification of patients with ST-segment elevation myocardial infarction receiving emergency interventional therapy.Methods A total of 425 ST-segment elevation myocardial infarction patients who received primary percutaneous coronary intervention in Zhengzhou University People's Hospital from October 2017 to October 2019 were divided into three groups according to CHA2DS2-VASc score(group 1:1-2 points,group 2:3-4 points,group 3:>4 points).The emergency intervention operation and the occurrence of major adverse cardiovascular events in hospital were discussed,and the validity was verified by ROC curve.Results Comparison of emergency intervention among the three groups:The proportion of patients with multi-vessel disease in group 1(29.37%)was significantly lower than that in group 2(45.95%)(P<0.05),group 2(45.95%)was lower than that in group 3(62.22%),but there was no significant difference(P>0.05),and that in group 1(29.37%)was lower than that in group 3(62.22%),and the difference was statistically significant(P<0.05);and the door to ballon time in group 1[90(84,107)]was lower than that in group 2[105(90,118)],group 2[105(90,118)]was lower than group 3[108(102,119)].The proportion of major adverse cardiovascular events in patients with different CHA2DS2-VASc scores was different,and the difference was statistically significant(P<0.001).The ROC curve showed that the area under the curve was 0.73 and 95%confidence interval was(0.68,0.78),and the best cut-off value was 3.5.Conclusion In clinical work,CHA2DS2-VASc score can be used for rapid risk stratification of patients with ST-segment elevation myocardial infarction receiving emergency interventional therapy,and the major adverse cardiovascular events in hospital are on the rise with the increase of score.