年龄、肌酐和射血分数评分对STEMI患者经皮冠状动脉介入术后1年预后的预测价值

Value of ACEF score in evaluating one-year prognosis after percutaneous coronary intervention in STEMI patients

目的:评价接受直接经皮冠状动脉介入手术(PCI)的ST段抬高型心肌梗死(STEMI)患者的年龄、肌酐和射血分数(ACEF)评分对于患者术后1年预后的预测价值。方法:回顾性纳入2014年6月-2018年6月于苏州大学附属第一医院行PCI术的STEMI患者754例,根据患者1年内是否出现主要不良心血管事件(MACE)分为病例组185例及对照组569例。收集患者的临床资料,计算ACEF评分,根据三分位数将患者分成低危组(ACEF评分≤1.09,258例)、中危组(1.09<ACEF评分≤1.46,248例)和高危组(ACEF评分>1.46,248例),比较3组患者1年内MACE的发生情况。结果:ACEF评分是STEMI患者1年内MACE发生的独立危险因素,与其他指标相比,其预测价值更高(AUC=0.784,95%CI:0.748~0.820,P=0.000)。高危组患者平均年龄更大,发生心房颤动、心力衰竭、室性心动过速以及心室颤动的比例更高(均P<0.05)。ACEF评分越高,术后1年内发生MACE的风险越高(log-rank P=0.000),发生时间越早。结论:ACEF评分对STEMI患者PCI术后1年预后有着良好的预测价值。

Objective:To investigate the value of age,creatinine,and ejection fraction(ACEF)scores in evaluating one-year prognosis after primary percutaneous coronary intervention(PCI)in patients with ST elevation myocardial infarction(STEMI).Method:A total of 754 patients with STEMI who underwent PCI in The First Affiliated Hospital of Soochow University from June 2014 to June 2018 were retrospectively included.They were divided into case group(n=185)and control group(n=569)based on whether patients had major adverse cardiovascular events(MACE)within one year.Then we collected clinical data of patients,calculated the ACEF score,and divided patients into low-risk group(ACEF score≤1.09,n=258),intermediate-risk group(1.09<ACEF score≤1.46,n=248)and high-risk group(ACEF score>1.46,n=248).The incidence of MACE within one year was compared among the three groups.Result:The ACEF score was an independent risk factor of MACE within one year in STEMI patients,and its predictive value was better than other indicators(AUC=0.784,95%CI:0.748-0.820,P=0.000).The average age of patients in the high-risk group was the oldest,the proportion of atrial fibrillation,heart failure,ventricular tachycardia and ventricular fibrillation was also the highest(all P<0.05).The higher the ACEF score,the higher the risk of MACE within one year after PCI(log-rank P=0.000),and the earlier the onset.Conclusion:The ACEF score has a great predictive value for one-year prognosis in STEMI patients after PCI.