Objective To clarify the value of Grace and Crusade scores for predicting the risk of long-term all-cause mortality and major adverse cardiovascular events in patients with atrial fibrillation and non-ST-elevation myocardial infarction(NSTEMI) after percutaneous coronary intervention(PCI).Methods A retrospective study was conducted on the data of 379 patients with atrial fibrillation and NSTEMI treated by PCI in 11 tertiary grade A hospitals in Beijing from January 2010 to January 2015.Grace score,Crusade score,Grace unite Crusade scores were used to predict the long-term prognosis of these patients.The area under the curve(AUC) of receiver operating characteristic(ROC) of these three predictors were recorded.In accordance with the results of combined assessment of Grace and Crusade scores,the patients were divided into four groups,G1 group(Grace score ≤118 points,Crusade score≤40 points,n=112),G2 group(Grace score ≤118 points,Crusade score ≥41 points,n=20),G3 group(Grace score >118 points,Crusade score ≤40 points,n=143) and G4 group(Grace score >118 points,Crusade score ≥ 41 points,n=104).The area under the curve(AUC) of receiver operating characteristic(ROC) of these three predictors were recorded.The survival curves of 4 groups were drawn and compared.Results Three hundred and sixty-two of the 379 recruited patients completed the follow-up of(36.8±18.3)months.For predicting the risk of long-term all-cause mortality of these participants,the AUC of Grace score,Crusade score,Grace unite Crusade scores respectively were 0.660 〔95%CI(0.609,0.709)〕,0.702 〔95%CI(0.652,0.749)〕,and 0.707 〔95%CI(0.658,0.754)〕.As for predicting the risk of long-term major adverse cardiovascular events,the AUC of Grace score,Crusade score,Grace unite Crusade scores respectively were 0.559 〔95%CI(0.506,0.611)〕,0.593 〔95%CI(0.540,0.644)〕,0.594 〔95%CI(0.542,0.645)〕.Survival analysis found that survival curve differed significantly among the G1,G2,G3 and G4 groups(χ2=20.07,P<0.01);G4 group had substantially lower survival rate than G1 and G3 groups(P<0.05).Conclusion For patients with atrial fibrillation and NSTEMI after PCI,these three predictors have certain predictive values in predicting the risk of long-term all-cause mortality,of them,Grace unite Crusade scores can be used for identifying the high-risk patients.The three predictors have similar values in predicting the risk of long-term major adverse cardiovascular events in these patients.%目的 分析Grace评分联合Crusade评分对心房颤动合并非ST段抬高型心肌梗死(NSTEMI)患者经皮冠状动脉介入(PCI)术后远期发生全因死亡及主要不良心血管事件的预测价值.方法 回顾性分析2010年1月-2015年1月于北京11家三级甲等医院就诊的心房颤动合并NSTEMI行PCI患者的相关资料.绘制Grace评分、Crusade评分及联合评分预测心房颤动合并NSTEMI患者PCI术后远期预后的受试者工作特征曲线(ROC曲线),计算3种方法ROC曲线下面积(AUC).依据联合评分将患者分为G1组(Grace评分≤118分,Crusade评分≤40分,n=112),G2组(Grace评分≤118分,Crusade评分≥41分,n=20),G3组(Grace评分>118分,Crusade评分≤40分,n=143),G4组(Grace评分>118分,Crusade评分≥41分,n=104).绘制并比较4组生存曲线.结果 共纳入379例患者,随访(36.8±18.3)个月,完成随访362例.Grace评分、Crusade评分及联合评分预测心房颤动合并NSTEMI患者PCI术后远期全因死亡风险的AUC分别为0.660〔95%CI(0.609,0.709)〕、0.702〔95%CI(0.652,0.749)〕、0.707〔95%CI(0.658,0.754)〕,预测PCI术后远期主要不良心血管事件风险的AUC分别为0.559〔95%CI(0.506,0.611)〕、0.593〔95%CI(0.540,0.644)〕、0.594〔95%CI(0.542,0.645)〕.G1、G2、G3、G4组的生存曲线比较,差异有统计学意义(χ2=20.07,P<0.01).G4组生存率低于G1、G3组(P<0.05).结论 Grace评分、Crusade评分、联合评分对心房颤动合并NSTEMI患者PCI术后远期全因死亡风险有一定的预测价值,且联合评分更能够筛选出高危患者;3种方法预测主要不良心血管事件风险的价值相当.
展开▼
