CHA_(2)DS_(2)-VASc评分对急性非ST段抬高型心肌梗死患者住院后1年结局事件的预测价值

Predictive Value of the CHA_(2)DS_(2)-VASc Score for Predicting One-year Outcomes Following Acute Non-ST Segment Elevation Myocardial Infarction

目的评估CHA_(2)DS_(2)-VASc评分对急性非ST段抬高型心肌梗死(NSTEMI)患者住院后1年结局事件的预测价值。方法分析冠心病医疗结果评价和临床转化研究(China PEACE)前瞻性急性心肌梗死研究中来自53家医院的790例NSTEMI患者的临床资料。按CHA_(2)DS_(2)-VASc评分将患者分为低(1~3分)、中(4~6分)、高(7~9分)分值组。采用多因素Logistic回归分析评估CHA_(2)DS_(2)-VASc评分对NSTEMI患者住院后1年结局事件的影响。绘制受试者操作特征(ROC)曲线评估CHA_(2)DS_(2)-VASc评分对急性NSTEMI患者1年全因死亡及主要不良心血管事件(MACE)的预测价值。结果入组790例患者年龄为56~72岁,中位年龄63岁,女性237例(30.0%)。CHA_(2)DS_(2)-VASc评分高分值组患者1年结局事件发生率更高,基础疾病更多(P<0.0001);多因素Logistic回归分析结果显示,1年全因死亡率(OR=13.90,95%CI:3.99-48.40,P<0.0001)、非致死性心肌梗死发生率(OR=4.96,95%CI:1.26-19.50,P<0.05)、因心力衰竭住院率(OR=8.57,95%CI:2.85-25.80,P<0.001)、MACE发生率(OR=7.83,95%CI:3.40-18.00,P<0.0001)均明显高于其他两组患者。CHA_(2)DS_(2)-VASc评分每增加1分,1年全因死亡率增加93.4%(P<0.0001),MACE发生率增加55.8%(P<0.0001),非致死性心肌梗死发生率增加36.1%(P<0.01),因心力衰竭住院率增加58.5%(P<0.0001)。ROC曲线显示,CHA_(2)DS_(2)-VASc评分与全球急性冠脉事件登记(GRACE)评分预测1年全因死亡率的曲线下面积(AUC)分别为0.778和0.877(P<0.01),二者预测MACE发生率的AUC分别为0.738与0.788(P=0.05)。结论CHA_(2)DS_(2)-VASc评分是一种有效预测NSTEMI患者住院后1年风险的评估工具,在预测MACE方面与GRACE评分价值相当,在预测全因死亡率方面略逊于GRACE评分;但其数据获取方便、计算简单,适于对NSTEMI患者进行早期快速分层。

Objective To explore the predictive value of the CHA_(2)DS_(2)-VASc score for one-year outcomes of patients with acute non-ST segment elevation myocardial infarction(NSTEMI).Methods Data of 790 patients from the China Patientcentered Evaluative Assessment of Cardiac Events(China PEACE)Prospective Acute Myocardial Infarction Study were analyzed retrospectively.The patients were categorized into 3 groups according to the CHA_(2)DS_(2)-VASc scores:the low score group(score 1-3),the middle score group(score 4-6)and the high score group(score 7-9).The CHA_(2)DS_(2)-VASc score was incorporated into Logistic analyses to determine its independent impact on one-year outcomes.Receiver operating characteristic(ROC)curves were constructed,and the area under the curve(AUC)was used to evaluate the predictive value of the CHA_(2)DS_(2)-VASc score for one-year all-cause mortality and major adverse cardiovascular events(MACE),respectively.Results The patients had a median age of 63(56,72)years,and 30.0%(237/790)of them were females.Patients with higher CHA_(2)DS_(2)-VASc scores had a higher one-year outcomes and more complications(P<0.0001).After adjustment of baseline covariates,the subjects in the high score group were associated with high risks of one-year all-cause mortality(OR=13.90,95%CI:3.99-48.40,P<0.0001),nonfatal myocardial infarction(OR=4.96,95%CI:1.26-19.50,P<0.05),rehospitalization for heart failure(OR=8.57,95%CI:2.85-25.80,P<0.001,and MACE(OR=7.83,95%CI:3.40-18.00,P<0.0001).The AUCs of the CHA_(2)DS_(2)-VASc score,comparing with Global Registry of Acute Coronary Events(GRACE)score,were similar in evaluation of one-year MACE(0.738 vs.0.788,P=0.05)and slightly lower in evaluation of mortality(0.778 vs.0.877,P<0.01).Conclusion The CHA_(2)DS_(2)-VASc score is an independent predictor of one-year outcomes for NSTEMI patients.Its predictive value is comparable with the GRACE score in predicting MACE and slightly inferior to the GRACE score in predicting all-cause mortality,which could be used as a simple tool for early and rapid outcome evaluation for NSTEMI patients.