CHA_(2)DS_(2)-VASc评分对急性心肌梗死患者预后的预测价值

Prognostic value of CHA_(2)DS_(2)-VASC scores to prognosis in patients with acute myocardial infarction

目的探讨CHA_(2)DS_(2)-VASc评分与急性心肌梗死(AMI)患者发生主要不良心血管事件(MACE)的关系。方法回顾性分析2018年8月至2019年5月于徐州医科大学附属医院心内科确诊的AMI患者的临床、实验室资料,并计算CHA_(2)DS_(2)-VASc评分。采用COX回归分析进行单因素和多因素分析,评估AMI的心血管危险因素。采用ROC曲线评估CHA_(2)DS_(2)-VASc评分预测MACE的效能。比较CHA_(2)DS_(2)-VASc评分对于急性ST段抬高型心肌梗死(STEMI)和非ST段抬高型心肌梗死(NSTEMI)患者预后的预测价值。根据CHA_(2)DS_(2)-VASc评分将AMI患者分为4组,建立模型,并进行Kaplan-Meier生存分析。结果随访2年中,505例AMI患者中152例(30.09%)发生MACE事件。经各种危险因素调整后的COX风险回归分析显示,CHA_(2)DS_(2)-VASc评分对MACE的预测价值仍有统计学意义(P<0.05)。CHA_(2)DS_(2)-VASc评分对于STEMI预后的预测价值高于对NSTEMI的预测(AUC分别为:0.706,0.681;敏感性分别为:53.93%,53.97%;特异性分别为:79.89%,75.74%)。Kaplan-Meier分析显示,高CHA_(2)DS_(2)-VASc评分的患者MACE发生率明显高于低CHA_(2)DS_(2)-VASc评分的患者(log-rank P<0.001)。结论CHA_(2)DS_(2)-VASc评分可能是AMI患者预后的重要预测因子,与预后密切相关。根据对CHA_(2)DS_(2)-VASc评分对AMI患者进行危险分层,有助于指导治疗,改善预后。

Objective To discuss the relationship between CHA_(2)DS_(2)-VASC scores and major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI).Methods AMI patients were chosen from Department of Cardiovascular Medicine in Affiliated Hospital of Xuzhou Medical University rom Aug.2018 to May 2019,and their clinical materials and laboratory data were retrospectively analyzed and CHA_(2)DS_(2)-VASC scores were calculated.COX regression analysis was used for single-factor and multi-factor analysis to review cardiovascular risk factors of AMI.The efficacy of CHA_(2)DS_(2)-VASC scores in predicting MACE was reviewed by using ROC curve.The predictive value of CHA_(2)DS_(2)-VASC scores to acute ST-segment elevation myocardial infarction(STEMI)and non-STEMI(NSTEMI)was compared.AMI patients were divided,according to CHA_(2)DS_(2)-VASC scores,into 4 groups,and a model was established and given a Kaplan-Meier survival analysis.Results MACE occurred in 152 AMI patients among 505 patients(30.09%)during 2 y follow-up period.The results of COX risk regression analysis showed that,after corrected different risk factors,the predictive value of CHA_(2)DS_(2)-VASC scores to MACE still had statistical significance(P<0.05).The predictive value of CHA_(2)DS_(2)-VASC scores to STEMI(AUC=0.706,sensitivity=53.93%,specificity=79.89%)was higher than that to NSTEMI(AUC=0.681,sensitivity=53.97%,specificity=75.74%).The results of Kaplan-Meier analysis showed that incidence rate of MACE was significantly higher in patients with high CHA_(2)DS_(2)-VASC scores than that in patients with low CHA_(2)DS_(2)-VASC scores(log-rank P<0.001).Conclusion CHA_(2)DS_(2)-VASC scores is an important predictive factor for prognosis in AMI patients,which is closely correlated to prognosis.AMI patients can be stratified according to CHA_(2)DS_(2)-VASC scores for guiding treatment and improving prognosis.