HEART与GRACE危险评分对急性冠脉综合征患者危险分层的对比研究

目的:探讨HEART与GRACE危险评分对急性冠脉综合症(ACS)患者主要心血管不良事件(MACE)发生的预测应用价值。方法:回顾性分析自2015年6月至2018年6月就诊于我院急诊入院的ACS患者591例,分别使用HEART与GRACE危险评分对研究对象进行危险分层(低危组,中危组,高危组),随访患者发病后90天MACE发生情况,分析不同危险分层ACS患者发病后90天MACE发生情况与评分之间的关系,并比较两种评分对ACS患者90天发生MACE事件的预测能力。结果:本研究纳入371例患者,其中男性324例(87.3%),女性47例(12.7%),年龄(58±11.70)岁;167患者(45.1%)在3个月内发生MACE。随着HEART和GRACE危险评分越高,发病90天发生MACE事件的发生率显著增加(P<0.05),HEART评分中高危组预测MACE准确性较GRACE评分高,GRACE评分低危险组预测MACE准确性较HEART评分高。HEART和GRACE评分对ACS患者预测MACE敏感性分别为76.51%,64.73%,特异性分别为96.71%,96.25%。HEART评分具有良好的预测价值,其ROC曲线下面积为0.908(95%CI 0.846~0.974),与GRACE评分ROC曲线下面积的0.801相比,差异有统计学意义(P<0.05)。结论:HEART和GRACE评分都可以应用于ACS患者的危险分层,预后评估和预测MACE发生,但HEART危险评分更可靠。

Comparative Study of Risk Stratification between HEART and GRACE in Patients with Acute Coronary Syndrome

ABSTRACT Objective: To explore the predictive value of HEART and GRACE risk score for major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS). Methods: Retrospective analysis was made on 591 ACS patients who were admitted to our hospital from June 2015 to June 2018. The risk stratification (low risk group, medium risk group and high risk group) of the study subjects was carried out by using HEART and GRACE risk score respectively. The occurrence of MACE was followed up 90 d after the onset of ACS, and the relationship between the occurrence of MACE and the score 90 d after the onset of ACS patients with different risk stratification was analyzed and the predictive ability of the two scoring systems for 90 d MACE events in ACS patients was compared. Results: 371 patients were enrolled in this study, including 324 males (87.3%), 47 females (12.7%) and 167 patients (45.1%) who developed MACE within 3 months. With the higher risk scores of HEART and GRACE, the incidence of 90d MACE events increased significantly(P<0.05), The accuracy of predicting MACE in high-risk group of HEART score was higher than GRACE score, while the accuracy of predicting MACE in low-risk group of GRACE score was higher than HEART score. The sensitivity of HEART and GRACE scores for predicting MACE in ACS patients was 76.51%, 64.73%, and specificity was 96.71% and 96.25%. HEART score has a good predictive value. The area under ROC curve is 0.908 (95% CI 0.846-0.974), compared with 0.801 under ROC curve of GRACE score, there is a significant difference (P<0.05). Conclusion: Both HEART and GRACE scores can be applied to risk stratification, prognosis assessment and prediction of MACE in ACS patients, but HEART risk score is more reliable.