急性冠状动脉事件的全球性注册研究评分和校正改良式早期预警系统评分在急性心源性胸痛患者中的应用

摘要

目的 探讨急性冠状动脉事件的全球性注册研究(GRACE)评分和校正改良式早期预警系统评分(MEWS)在急性心源性胸痛患者中的应用价值.方法 收集662例急性心源性胸痛患者的临床资料,包括患者就诊时的GRACE评分、MEWS评分、获得评分时间,以及患者是否急诊入院和30 d内死亡情况,分析并比较两种评分对急诊胸痛患者病情和预后的预测能力.结果 662例患者GRACE评分时间(78.76±10.85) min,MEWS评分时间(4.55±1.77)min,t=108.456,P＜0.001.662例患者中,急诊住院412例,留院观察250例.急诊住院治疗的患者GRACE评分[(150.22±36.91)分]高于留院观察患者[(96.36±44.09)分],t=16.892,P＜0.001;急诊住院治疗的患者MEWS评分[(5.46±2.20)分]和高于留院观察患者[(3.15±1.83)分],t=13.932,P＜0.001.662例患者中,30 d内死亡35例,30 d内存活627例.30 d内死亡的患者GRACE评分[(171.69±39.53)分]和高于30 d内存活组[(127.55±46.91)分],t=5.458,P＜0.001;30 d内死亡的患者MEWS评分[(5.66±2.01)分]和高于30 d内存活患者[(4.53±2.36)分],t=2.780,P=0.006.GRACE评分预测患者急诊住院和30 d内死亡ROC曲线下面积(AUC)分别为0.826和0.751,MEWS评分预测患者急诊住院和30 d内死亡的AUC分别为0.785和0.643;两种评分相比,MEWS评分获得时间显著短于GRACE评分,而GRACE评分在判断患者急诊住院和30 d死亡的准确度优于MEWS评分.结论 GRACE评分和MEWS评分均能帮助判断急性心源性胸痛患者的病情和预后,MEWS评分具有更快捷的优势,而GRACE评分对于患者住院和预后判断更准确.%Objective To explore the application value of global registry of acute coronary events (GRACE) score and modified early warning score(MEWS) in patients with acute cardiogenic chest pain.Methods A total of 662 patients with acute cardiogenic chest pain were collected from Jan 2015 to Dec 2016.The clinical data,including GRACE score,MEWS score,time required for scorings,and emergency hospitalization and death within 30 days were collected,then analyzed and compared the predictive ability of the two scores on the severity and prognosis.Results The mean time of GRACE scoring was(78.76 ± 10.85)min,which was significantly more than MEWS (4.55 ± 1.77) min(t =108.456,P ＜0.001).Four hundreds and twelve of the 662 patients were be in hospital by emergency,and 250 were detained for observation.The GRACE score of the patients in hospital by emergency was (150.22 ± 36.91),was significantly higher than the observation (96.36 ± 44.09) (t =16.892,P ＜ 0.001).The MEWS score of the patients in hospital by emergency was (5.46 ± 2.20),was significantly higher than the observation (3.15 ± 1.83) (t =13.932,P ＜ 0.01).Thirty-five of the 662 patients were died within 30 days,while 627 patients were survival within 30 days.The GRACE score of the patients died within 30 days was (171.69 ± 39.53),it was significantly higher than the patients survival within 30 days (127.55 ± 46.91) (t =5.458,P ＜ 0.001).The MEWS score of the patients died within 30 days was (5.66 ± 2.01),was significantly higher than the patients survival within 30 days (4.53 ± 2.36) (t =2.780,P =0.006).There were significant differences in AUC of GRACE score for patients were be in hospital by emergency (AUC =0.826) and 30-day death (AUC =0.751),and the AUC of MEWS for patients were be in hospital by emergency and 30 day death were 0.785 and 0.643,the GRACE score was superior to the MEWS in determining patients' emergency hospitalization and mortality within 30 days.Conclusion Both of the GRACE and MEWS scores can help evaluate the severity and prognosis of patients with acute cardiogenic chest pain,while the MEWS more quickly and the GRACE more accurate.