改良的ACEF评分对合并糖尿病的ST段抬高型心肌梗死患者的预测价值

Predictive value of the modified ACEF score in patients with ST-segment elevation myocardial infarction in combination with diabetes mellitus

目的以年龄、肌酐、射血分数评分(ACEF评分)为基础,通过联合其他危险因素建立新的评分来提高预测急性ST段抬高型心肌梗死(STEMI)患者发生主要不良心脑血管事件(MACCE)的准确性,尤其是对合并糖尿病的STEMI的患者。方法回顾性收集了2016年8月年至2020年8月在暨南大学附属第一医院诊断为STEMI并行经皮冠状动脉介入治疗(PCI)的282名患者的临床资料,其中包括了85名合并糖尿病的患者。通过多因素Logistic回归分析筛选危险因素,将ACEF评分与危险因素相结合形成新的评分体系ACEF-all,并利用ROC曲线分析评估预测ACEF-all效能。结果ACEF评分联合高血压病史、心源性休克、首次医疗接触到球囊通过的时间(FMC-B)、三支血管病变等4个变量建立的ACEF-all评分比原始ACEF评分具有更好的辨别能力(AUC从0.579增加到0.712,P=0.045变成P<0.001)。ACEF-all评分在预测合并糖尿病的STEMI患者发生MACCE亦具有较高的预测效能(AUC=0.782,P<0.0001)。结论新的ACEF-all评分体系为STEMI患者提供了更好的预测价值,在预测合并糖尿病的STEMI患者发生MACCE也具有较高的预测效能。

Objective The aim of this study was to improve the accuracy of predicting major adverse cardiovascular and cerebrovascular events(MACCE)in patients with acute ST-segment elevation myocardial infarction(STEMI),especially in patients with diabetes mellitus,based on the ACEF score(age,creatinine,and ejection fraction score)by establishing a new score in association with other risk factors.Methods We retrospectively collected 282 patients diagnosed with STEMI undergoing PCI(percutaneous coronary intervention)in the First Affiliated Hospital of Jinan University from August 2016 to August 2020,including 85 patients with diabetes.The risk factors were screened by multivariate Logistic regression analysis,and a new scoring system ACEF-all was formed by combining the ACEF score with riskfactors.The prediction efficiency was evaluated by ROC curve analysis.Results The ACEF score established by combined with history of hypertension,cardiogenic shock,time of first medical contact to balloon(FMC-B),and three-vessel disease has better discrimination than the original ACEF score(AUC increased from 0.579 to 0.712,P=0.045 to P<0.001).The ACEF-all score also had high predictive power in predicting MACCE in STEMI patients with diabetes(AUC=0.782,P<0.0001).Conclusions The new ACEF-all score provides better predictive value for STEMI patients undergoing PCI,and has higher predictive efficacy for MACCE in STEMI patients with diabetes mellitus.