JCSA风险评分系统对中国变异型心绞痛患者的预后评估

Prognosis evaluation of Chinese variant angina patients by JCSA risk score

目的:探讨日本冠状动脉痉挛协会(JCSA)风险评分系统对中国变异型心绞痛患者危险分层及不良预后的预测作用。方法:回顾性分析郑州大学第一附属医院2010年12月-2019年6月收治入院的变异型心绞痛患者的临床资料,根据患者有无院外心脏骤停史、吸烟、静息心绞痛、器质性冠状动脉(冠脉)狭窄、多支血管痉挛、心绞痛期间ST段抬高和β-受体阻滞剂使用情况,用JCSA风险评分系统对变异型心绞痛患者进行评分分层,观察并记录主要不良心血管事件(MACE)发生例数。结果:总共筛选出200例患者,189例纳入研究,其中低危组0例,中危组115例,高危组74例,平均随访(24±23)个月,失访4例(3例高危,1例中危)。其中中危组MACE发生率为7.01%(8例次);高危组MACE发生率为14.1%(10例次);中危组和高危组人群分别与JCSA研究的人群的MACE数进行比较,差异无统计学意义(χ2=0.000 09,P=0.992;χ2=0.051,P=0.822)。结论:JCSA风险评分系统可以作为一个有效的预测工具为变异型心绞痛患者提供全面的风险评估和预后分层,可以通过控制相关危险因素改善患者预后。

Objective:To explore prognosis of Chinese variant angina(VA) patients by JCSA risk score(Japanese Coronary Spasm Association risk score,JCSA risk score).Method:After retrospective screening of all consecutive VA patients in the First Affiliated Hospital of Zhengzhou University from December 2010 to June 2019,all patients were graded by JCSA risk score according to the history of out-of-hospital cardiac arrest,smoking,resting angina pectoris,organic coronary artery stenosis,multi-vessel spasm,ST-segment elevation during angina pectoris and the use of beta-blockers.The main adverse cardiovascular events(MACE) were observed including cardiogenic death,non-fatal myocardial infarction,readmission due to angina attack and heart failure.Result:A total of 200 VA patients were screened and 189 of them were included in this study.Low risk group:0 cases;Middle risk group:115 cases;High risk group:74 cases.Following up for(24±23) months but 4 cases(3 high-risk cases,1 middle-risk case) were lost to follow-up.The number of MACEs in low-risk group,middle-risk group and high-risk group was 0,8(7.01%) and 10(14.1%) respectively.There was no significant difference in the number of MACEs in the middle risk group and the high risk group between our study and Japanese study(χ~2=0.000 09,P=0.992;χ~2=0.051,P=0.822).Conclusion:JCSA risk score system can be used as an effective predictive tool to provide comprehensive risk assessment and prognostic stratification for VA patients.We can improve the prognosis of patients by controlling predictive factors.