TIMI危险评分对ST段抬高型冠状动脉非阻塞性心肌梗死患者远期预后的预测价值

Prognostic Value of TIMI Risk Scores in Patients With ST-elevation Myocardial Infarction With Nonobstructive Coronary Arteries

目的:探究TIMI危险评分对ST段抬高型冠状动脉(冠脉)非阻塞性心肌梗死(MINOCA)患者远期预后的预测价值。方法:回顾性纳入2015年1月至2019年12月在中国医学科学院阜外医院行冠脉造影并诊断为ST段抬高型MINOCA患者461例,根据患者TIMI危险评分分为低危组(≤3分,n=157)和中高危组(>3分,n=304),收集患者临床数据并进行随访(中位随访时间41.7个月),分析两组患者临床特征及随访时间内主要不良心血管事件(MACE)发生情况,并进行Cox回归分析评估MACE的影响因素,绘制Kaplan-Meier曲线及ROC曲线。结果:低危组和中高危组患者的MACE发生率分别为8.9%和18.1%,差异有统计学意义(P<0.05)。Cox回归分析显示,低危组与较低的MACE风险独立相关(HR=0.468,95%CI:0.258~0.849,P=0.013)。ROC曲线分析提示TIMI危险评分对ST段抬高型MINOCA患者具有一定的预后预测价值(AUC为0.679)。结论:TIMI危险评分对ST段抬高型MINOCA患者远期预后具有潜在预测价值。

Objectives:To investigate the predictive value of TIMI risk scores for long-term prognosis of patients with ST-elevation myocardial infarction with non-obstructive coronary arteries(MINOCA).Methods:A total of 461 patients diagnosed with ST-elevation MINOCA who underwent coronary angiography in Fuwai Hospital from January 2015 to December 2019 were enrolled.Patients were divided into low-risk group(≤3,n=157)and intermediate-high risk group(>3,n=304)according to TIMI risk scores.The clinical characteristics and outcomes of the patients were assessed.Cox regression analysis,Kaplan-Meier and ROC curve analysis were performed.Results:The incidence of total major adverse cardiovascular events(MACE)was significantly higher in patients with intermediate-high TIMI risk scores than in patients with low TIMI risk scores(18.1%vs.8.9%,P=0.004)during the median follow-up of 41.7 months.Cox regression analysis showed that low-risk group was independently associated with lower risk of MACE(HR=0.468,95%CI:0.258-0.849,P=0.013).The AUC was 0.679,suggesting that the TIMI risk score is a useful predictor of long-term MACE among ST-segment elevation MINOCA patients.Conclusions:TIMI risk score serves as a useful predictor of long-term prognosis of patients with ST-segment elevation MINOCA.