GRACE评分对实施PCI的STEMI患者冠脉无复流和MACE事件的预测价值

The GRACE risk score predicts no-reflow and MACE in patients with STEMI undergoing PCI

目的评估GRACE评分对接受经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者冠状动脉无复流和主要心血管不良事件(MACE)的预测作用。方法连续入选甘肃省人民医院和西安交通大学第一附属医院于2009年1月至2011年12月收治的STEMI患者1118例。记录主要人口学资料、心血管危险因素及血脂等生化指标。采用标准的Judkins技术并经桡动脉进行冠状动脉造影。冠状动脉无复流判定至少由2名有经验的心脏病专家独立进行评估。使用标准的计算机程序进行GRACE风险评分的计算。所有病例均通过医疗记录、面对面访谈或电话进行随访,并分析GRACE评分对实施PCI的STEMI患者冠脉无复流和MACE事件的预测价值。结果在中位时间36个月的随访期间,1118例患者中有58例(5.2%)失访,其余1060例患者中,118例(11.1%)发生无复流现象,147例(13.9%)发生MACE事件。无复流患者GRACE评分显著高于正常血流患者。多因素Logistic回归分析显示,GRACE评分是STEMI患者PCI过程中发生冠脉无复流的独立预测因子(OR=1.034;P=0.002)。多因素Cox回归分析显示,GRACE评分是MACE的独立预测因子。冠脉无复流和MACE的ROC曲线下面积分别为0.719和0.697。Kaplan-Meier分析显示,因心衰再住院、再梗死、全因死亡和累积心血管事件概率随GRACE评分的升高而增加。结论GRACE评分是STEMI患者发生冠脉无复流和MACE事件的一种可靠的预测评分系统。

Objective Coronary no-reflow during percutaneous conranary intervention(PCI)often results in the failure of ischemic myocardial reperfusion and major adverse cardiovascular events(MACE).The present study sought to evaluate whether the GRACE risk score can predict coronary no-reflow in STEMI patients undergoing PCI.Methods We consecutively recruited 1118 patients with STEMI who were admitted to Gansu Provincial People’s Hospital and The First Affiliated Hospital of Xi’an Jiaotong University from January 2009 to December 2011.Main demographic data,cardiovascular risk factors,blood lipid and other biochemical indicators were recorded.Coronary angiography was performed by a radial artery approach using the standard Judkins technique.Coronary no-reflow was evaluated by at least two independent experienced cardiologists.The GRACE risk score was calculated with a computer program.All the cases were followed up by medical records,face-to-face interviews or telephone calls.Finally,we analyzed the predictive value of the GRACE risk score for coronary non-reflow and MACE in STEMI patients undergoing PCI.Results During a median period of 36 months,58 of the 1118 patients(5.2%)were lost to follow-up.Of the remaining 1060 patients,118(11.1%)had no-reflow and 147(13.9%)had MACE.The GRACE score was higher in patients with no-reflow than those without no-reflow.Multivariate logistic regression established that the GRACE score was an independent predictor for coronary no-reflow(OR=1.034;P=0.002).And multivariate Cox analysis showed the GRACE score was an independent predictor of MACE.The area under the ROC curve for coronary no-reflow and MACE was 0.719 and 0.697,respectively.Kaplan-Meier analysis showed that the probability of rehospitalization for heart failure,reinfarction,all-cause death and cumulative cardiovascular events increased with the increase of the GRACE risk score.Conclusion The GRACE risk score is a readily available predictive scoring system for coronary no-reflow and MACE in STEMI patients.