急性冠脉综合征的不同评分工具对介入治疗后患者预后评估的价值

The value of different scores of acute coronary syndrome in evaluating the prognosis of patients after interventional therapy

目的分析不同急性冠脉综合征评分工具,对介入治疗后患者预后评估的应用价值。方法将2020年8月至2021年4月承德医学院附属医院心血管内科收治的急性冠脉综合征患者400例纳入研究,均接受介入治疗后随访1年,收集其临床资料并进行回顾性分析。以随访期间出现主要不良心血管事件(MACE)的情况分为预后不良组(92例)和预后良好组(308例),根据不同全球急性冠状动脉事件注册(GRACE)、心肌梗死溶栓治疗临床试验(TIMI)、韩国急性心肌梗死注册表(KAMIR)得分分为低危组、中危组、高危组,通过单因素和多因素logistic回归分析法分析急性冠脉综合征介入治疗后预后不良发生的危险因素。结果急性冠脉综合征患者介入治疗后随访1年,发生预后不良92例(23.00%)。随着GRACE、TIMI、KAMIR评分增加MACE发生率、Gensini评分有升高趋势(P<0.05)。多因素logistic分析结果显示,高龄、心功能Killip分级Ⅲ~Ⅳ级、冠状病变支数>3支、发病至经皮冠状动脉介入治疗(PCI)时间、病灶长度及GRACE、TIMI、KAMIR、Gensini评分升高为预后不良的危险因素(OR=2.119、2.241、2.321、2.217、2.309、1.829、2.079、2.026、2.423,P<0.05)。结论急性冠脉综合征介入治疗后的患者不良预后与高龄、心功能Killip分级Ⅲ~Ⅳ级、冠状病变支数>3支、发病至PCI时间、病灶血管长度及GRACE、TIMI、KAMIR、Gensini评分升高密切相关,GRACE、TIMI、KAMIR评分在急性冠脉综合征患者介入治疗后的预后评估中有良好的应用价值。

Objective To analyze the value of different scores of acute coronary syndrome in evaluating the prognosis of patients after interventional therapy.Methods A total of 400 patients with acute coronary syndrome treated in department of cardiovascular medicine,affiliated hospital of chengde medical college from August 2020 to April 2021 were included in the study.All of them received interventional therapy and were followed up for 1 year,their clinical data collected and conducted retrospectively.The major adverse cardiovascular events(MACE)during follow-up for 1 year was the basis for poor prognosis,and the patients were divided into the poor prognosis group(n=92)and the good prognosis group(n=308).The global registry of acute coronary events(GRACE),thrombolysis in myocardial infarction(TIMI),and the Korea acute myocardial infarction registry(KAMIR)of the low-risk group,the intermediate-risk group,and the high-risk group were analyzed,and univariate and multivariate logistic regression analysis were used to analyze the risk factors of poor prognosis after interventional therapy in acute coronary syndrome.Results During 1 year follow-up,92 patients with acute coronary syndrome had poor prognosis after intervention,and the incidence of poor prognosis was 23.00%.The incidence of MACE and Gensini score increased with the increase of GRACE,TIMI and KAMIR score risk classification(P<0.05).The results of multivariate logistic analysis showed that increasing age,cardiac function Killip class Ⅲ-Ⅳ,coronary angiography lesions>3 vessels,and elevated time from onset to PCI,lesion vessel length,scores of GRACE,TIMI,KAMIR,and Gensini were risk factors associated with poor prognosis in patients with acute coronary syndrome(OR=2.119,2.241,2.321,2.217,2.309,1.829,2.079,2.026,2.423,P<0.05).Conclusions The poor prognosis of interventional intervention still exists in patients with acute coronary syndrome,its occurrence is associated with age increase,the cardiac function Killip class Ⅲ-Ⅳ,the number of coronary angiography lesions more than 3,and the elevated time from onset to PCI,lesion vessel length,scores of GRACE,TIMI,KAMIR and Gensini.The scores of GRACE,TIMI and KAMIR have good application value in the evaluation of coronary conditions and interventional prognosis in patients with acute coronary syndrome.