GRACE评分及PARIS评分对非ST段抬高型心肌梗死患者远期主要心血管不良事件的预测价值

Values of GRACE score and PARIS score to the prediction of long-term adverse cardiovascular events in patients with non-ST elevation myocardial infarction

目的观察非ST段抬高型心肌梗死(non-ST elevation myocardial infarction,NSTEMI)患者全球急性冠状动脉事件登记(global registry of acute coronary events,GRACE)评分及支架术后抗血小板药物停药模式(patterns of non-adherence to antiplatelet regimens in stented patients,PARIS)评分情况,探讨其对NSTEMI患者出院后3年内发生主要心血管不良事件(major adverse cardiovascular events,MACEs)的预测价值。方法698例NSTEMI患者根据出院后3年内是否发生MACEs分为预后不良组176例和预后良好组522例,比较2组年龄、血肌酐水平及入院时GRACE评分、PARIS评分等;采用多因素Cox回归分析NSTEMI患者出院后3年内发生MACEs的影响因素;绘制ROC曲线,评估入院时GRACE评分、PARIS评分及血肌酐预测NSTEMI患者出院后3年内发生MACEs的效能。结果预后不良组糖尿病(46.02%)、贫血(30.68%)、出院时三联抗血小板治疗(13.64%)比率,年龄[66.00(58.00,76.00)岁],血肌酐[85.00(67.95,114.19)μmol/L]、空腹血糖[7.58(5.79,10.34)mmol/L]水平及入院时GRACE评分[130.00(102.75,158.00)分]、PARIS评分[5.00(3.00,7.00)分]均高于预后良好组[31.03%、13.60%、2.11%、61.00(51.00,70.00)岁、72.00(61.00,89.14)μmol/L、6.96(5.41,9.44)mmol/L、114.00(94.00,136.00)分、4.00(2.00,5.00)分](P<0.05),男性、吸烟史比率,体质量指数、血小板计数、左室射血分数及血红蛋白、低密度脂蛋白胆固醇、白蛋白水平均低于预后良好组(P<0.05)。出院时三联抗血小板治疗(OR=1.634,95%CI:1.128~1.919,P=0.017)、血肌酐(OR=1.004,95%CI:1.001~1.012,P=0.021)、入院时PARIS评分(OR=1.322,95%CI:1.199~1.357,P<0.001)是NSTEMI患者出院后3年内发生MACEs的影响因素。入院时GRACE评分、PARIS评分、血肌酐分别以128.50分、5.50分、76.27μmol/L为最佳截断值,预测NSTEMI患者出院后3年内发生MACEs的AUC分别为0.669(95%CI:0.622~0.716,P<0.001)、0.756(95%CI:0.712~0.800,P<0.001)、0.646(95%CI:0.597~0.695,P<0.001),灵敏度分别为62.3%、60.2%、62.4%,特异度分别为68.4%、79.5%、59.1%。结论出院后3年内发生MACEs的NSTEMI患者入院时GRACE评分和PARIS评分均明显增高;与GRACE评分相比,PARIS评分对NSTEMI患者出院后3年内发生MACEs的预测价值较高。

Objective To observe the scores of global registry of acute coronary events(GRACE)and patterns of non-adherence to antiplatelet regimens in stented patients(PARIS)in patients with non-ST elevation myocardial infarction(NSTEMI),and to investigate their values to the prediction of major adverse cardiovascular events(MACEs)in 3years after discharge.Methods According to the occurrence of MACEs in 3years after discharge,698patients with NSTEMI were divided into poor prognosis group(n=176)and good prognosis group(n=522).The age,serum creatinine level,GRACE score and PARIS score on admission were compared between two groups.Multivariate Cox regression analysis was used to analyze the influencing factors of MACEs in patients with NSTEMI in 3years after discharge.ROC curve was drawn to evaluate the efficiencies of GRACE score,PARIS score and serum creatinine on predicting MACEs in patients with NSTEMI in 3years after discharge.Results The percentages of patients with diabetes and anemia,receiving triple antiplatelet therapy on discharge,age,serum creatinine level,fasting plasma glucose level,GRACE score and PARIS score were higher in poor prognosis group[46.02%,30.68%,13.64%,66.00(58.00,76.00)years,85.00(67.95,114.19)μmol/L,7.58(5.79,10.34)mmol/L,130.00(102.75,158.00),5.00(3.00,7.00)]than those in good prognosis group[31.03%,13.60%,2.11%,61.00(51.00,70.00)years,72.00(61.00,89.14)μmol/L,6.96(5.41,9.44)mmol/L,114.00(94.00,136.00),4.00(2.00,5.00)](P<0.05),while the male ratio,smoking history rate,body mass index,platelet count,left ventricular ejection fraction,hemoglobin,low-density lipoprotein cholesterol and albumin were lower in poor prognosis group than those in good prognosis group(P<0.05).The triple antiplatelet therapy on discharge(OR=1.634,95%CI:1.128-1.919,P=0.017),serum creatinine level(OR=1.004,95%CI:1.001-1.012,P=0.021)and PARIS score(OR=1.322,95%CI:1.199-1.357,P<0.001)were the influencing factors of MACEs in patients with NSTEMI in 3years after discharge.When the optimal cut-off values of GRACE score,PARIS score and serum creatinine were 128.50,5.50and 76.27μmol/L,the AUCs for predicting MACEs were 0.669(95%CI:0.622-0.716,P<0.001),0.756(95%CI:0.712-0.800,P<0.001)and 0.646(95%CI:0.597-0.695,P<0.001),the sensitivities were 62.3%,60.2%and 62.4%,and the specificities were 68.4%,79.5%and 59.1%,respectively.Conclusion NSTEMI patients with MACE in 3years after discharge have significantly high GRACE and PARIS scores on admission,and PARIS score has a higher predictive value than GRACE score.