ACEF评分对冠心病患者冠状动脉病变严重程度的预测价值

Predictive value of the ACEF score in severity of coronary artery stenosis of coronary heart disease patients

目的:探讨年龄、肌酐和射血分数(ACEF)评分对冠心病患者冠状动脉病变严重程度和院内不良心血管事件的预测价值。方法:回顾性分析武汉大学中南医院2019年1—12月首次行冠状动脉造影确诊为冠心病的患者748例,按照ACEF评分分为低分组(≤1.00)364例和高分组(>1.00)384例,比较两组患者的临床基线资料、冠脉造影结果、院内不良心血管事件发生率。使用相关性分析及回归分析分析冠脉狭窄程度的危险因素。采用受试者工作特征(ROC)曲线分析ACEF评分预测高冠脉积分及院内不良心血管事件的效能。结果:ACEF高分组Gensini评分较ACEF低分组高(58.0 vs 43.8,P<0.01)。Spearman相关分析提示ACEF评分与Gensini评分呈正相关(ρ=0.253,P<0.01)。多元线性回归分析及Logistic回归分析显示高ACEF评分是高Gensini评分的独立危险因素。ACEF评分预测高冠脉积分ROC曲线下面积为0.717(95%CI:0.633~0.801,P<0.01)。当ACEF为1.056,其诊断效率最高,敏感度为75.6%,特异度为58.6%。结论:高ACEF评分的冠心病患者多合并更多的心血管危险因素及更严重的冠脉病变。ACEF评分对冠心病患者的院内不良心血管事件具有一定预测效能。

Objective: To study the predictive value of the age, creatinine, and ejection fraction(ACEF)score in degree of coronary artery stenosis and in-hospital major adverse cardiovascular events(MACE) in patients with coronary heart disease. Methods: A retrospective analysis of 748 patients diagnosed with coronary heart disease identified by coronary angiography during January 2019 to December 2019 in Zhongnan Hospital of Wuhan University were included. According to the ACEF score,364 cases were divided into low ACEF scores group(≤1. 00) and 384 cases were divided into high ACEF scores group(>1. 00). The clinical baseline data, coronary angiography results, and the incidence of in-hospital MACE were compared between the two groups. Correlation analysis and regression analysis were used to analyze the risk factors of coronary artery stenosis. The receiver operating characteristic(ROC) curve was used to analyze the effectiveness of ACEF scores in predicting high coronary artery scores and in-hospital MACE. Results: The groups with high ACEF scores had higher Gensini scores than lower groups(58. 0 vs 43. 8, P<0. 01). Spearman correlation analysis indicated that ACEF score was correlated with Gensini score(ρ=0. 253, P<0. 01). Multiple linear regression analysis and logistic regression analysis showed that high ACEF score is an independent risk factor of high Gensini score. ACEF score predicted that the area under the ROC curve of high coronary artery scores was 0. 717(95%CI:0. 633-0. 801, P<0. 01). When ACEF was 1. 056, its diagnostic efficiency was the highest, with a sensitivity of 75. 6% and a specificity of 58. 6%. Conclusion: Patients with high ACEF scores have more cardiovascular risk factors and more severe coronary artery disease. ACEF score has certain predictive power for in-hospital MACE in patients with coronary heart disease.