摘要
目的探讨CHA_(2)DS_(2)-VASc评分对ST段抬高型急型心肌梗死(STEMI)患者行直接经皮冠状动脉介入治疗(PCI)后发生无复流现象和预后的预测价值。方法纳入2017年1月至2018年12月行直接PCI治疗的402例STEMI患者。根据CHA_(2)DS_(2)-VASc评分预测主要不良心血管事件(MACE)的最佳截断值将患者分为2组,分析CHA_(2)DS_(2)-VASc评分对行直接PCI的STEMI患者发生无复流和远期预后的影响。结果CHA_(2)DS_(2)-VASc评分对于MACE预测能力的接受者操作特征(ROC)曲线结果显示,曲线下面积(AUC)=0.723(95%CI:0.656~0.791,P<0.001),最佳截断值为CHA_(2)DS_(2)-VASc≥3,敏感度为70.3%,特异度为87.3%。将患者分为CHA_(2)DS_(2)-VASc<3组(n=287)和CHA_(2)DS_(2)-VASc≥3组(n=115)。CHA_(2)DS_(2)-VASc评分预测直接PCI术后无复流现象的最佳截断值为CHA_(2)DS_(2)-VASc≥2(AUC=0.648,95%CI:0.578~0.718,P<0.001),敏感度为71.8%,特异度为53.7%。Logistic多因素回归结果显示,CHA_(2)DS_(2)-VASc≥3是无复流的独立预测因子。Kaplan-Meier生存分析发现CHA_(2)DS_(2)-VASc≥3组的患者MACE、全因死亡和心力衰竭的发生率均高于CHA_(2)DS_(2)-VASc<3组患者,但对于再次血运重建2组并无统计学差异。Cox比例风险模型也证实CHA_(2)DS_(2)-VASc≥3可以独立预测MACE的发生。结论对于行直接PCI术后STEMI患者发生无复流和远期预后,CHA_(2)DS_(2)-VASc评分具有一定的预测价值。
Objective To investigate the predictive value of CHA_(2)DS_(2)-VASc score in patients with ST-segment elevation acute myocardial infarction(STEMI)after the no-reflow phenomenon and the long-term prognosis after primary percutaneous coronary intervention(PCI).Methods A retrospective analysis of 402 patients with STEMI who underwent primary PCI from January 2017 to December 2018 was performed.A CHA_(2)DS_(2)-VASc score of≥3 was used as the best cut-off value of MACE.The patients were divided into two groups,and the effect of the CHA_(2)DS_(2)-VASc score on the no-reflow phenomenon and long-term prognosis of patients with STEMI undergoing primary PCI was analyzed.Results The receiver operating characteristic curve of the CHA_(2)DS_(2)-VASc score for MACE showed that the area under the curve(AUC)was 0.723(95%CI:0.656-0.791,P<0.001),the best cut-off value of the CHA_(2)DS_(2)-VASc score was≥3,the sensitivity was 70.3%,and specificity was 87.3%.The patients were divided into the CHA_(2)DS_(2)-VASc score<3 group(n=287)and the CHA_(2)DS_(2)-VASc score≥3 group(n=115).The CHA_(2)DS_(2)-VASc score predicted that the best cut-off value of the score and its effect on no-reflow after primary PCI was CHA_(2)DS_(2)-VASc≥2(AUC=0.648,95%CI:0.578-0.718,P<0.001);the sensitivity was 71.8%,and the specificity was 53.7%.Logistic multivariate regression proved that CHA_(2)DS_(2)-VASc≥3 was an independent predictor of no-reflow.Kaplan-Meier survival analysis found that patients with higher CHA_(2)DS_(2)-VASc scores had higher rates of MACE,all-cause mortality,and heart failure than patients with lower scores;however,there was no significant difference in repeat PCI between the two groups.The Cox proportional hazard model also proved that CHA_(2)DS_(2)-VASc≥3 could independently predict event.Conclusion For patients with STEMI after primary PCI,the CHA_(2)DS_(2)-VASc score has a preliminary predictive value for the no-reflow phenomenon and the long-term prognosis.
作者
张嵚垚
胡美荣
孙佳莹
马淑梅
ZHANG Qinyao;HU Meirong;SUN Jiaying;MA Shumei(Department of Cardiology,Shengjing Hospital of China Medical University,Shengyang 110004,China,Shengjing Hospital of China Medical University,Shengyang 110004,China;Department of Cardiac Function,Shengjing Hospital of China Medical University,Shengyang 110004,China)
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2021年第4期356-361,共6页
Journal of China Medical University
