超敏肌钙蛋白I联合GRACE2.0评分对ACS患者近期死亡风险的预测价值

摘要

目的 评估入院时超敏肌钙蛋白I(hs-TnI)联合全球急性冠状动脉事件注册(GRACE)2.0评分在急性冠状动脉综合征(ACS)患者近期死亡风险预测中的价值.方法 回顾性地分析川北医学院附属医院2015年12月至2016年12月收治的347例ACS患者入院时的hs-TnI水平和GRACE2.0评分,随访观察hs-TnI和GRACE2.0评分高低对ACS患者近期(30 d)心血管疾病病死率的影响,并应用Kapian-Meier生存曲线分析hs-TnI和GRACE2.0评分对ACS患者近期心血管病死率的影响.结果 死亡组hs-TnI平均值[(7.5±5.6)μg/L]明显高于存活组[(1.2±2.9)μg/L],P<0.01,ACS患者近期心血管病死率与hs-TnI呈明显正相关(P<0.01).Kapian-Meier生存曲线分析hs-TnI对ACS患者近期心血管病死率影响,hs-TnI>0.014μg/L者近期预后明显较差(Log rank 62.81,P<0.01);GRACE2.0评分积分与ACS患者30 d心血管病死率呈明显的正相关(P<0.01),随着CRACE危险评分的增加,极高危ACS患者近期生存率明显降低(Log rank 116.56,P<0.01).而hs-TnI的生存曲线下面积(AUC)为0.079(95%CI:0.75~0.83,P<0.01),GRACE2.0评分AUC为0.81(95%CI:0.79~0.84,P<0.01).二者比较,GRACE2.0风险评分预测价值较hs-TnI稍高.hs-TnI与GRACE风险评分联合可以提高预测ACS患者近期心血管病死率的价值[AUC=0.84(0.81~0.91)].结论 hs-TnI联合GRACE2.0评分在ACS患者近期心血管死亡风险具有重要预测价值.%Objective To evaluate the value of high sensitive troponin I (hs-TnI) combined with the Global Registry of A-cute Coronary Events (GRACE) 2 .0 score in the prediction of death risk in the patients with acute coronary syndrome (ACS) . Methods The hs-TnI levels and GRACE2 .0 scores at admission in 347 ACS patients treated in the hospital from December 2015 to December 2016 were retrospectively analyzed .The follow up was performed for observing the effect of hs-TnI level and GRACE2 . 0 score on the short term (30 d) mortality rate of cardiovascular diseases .And the Kapian-Meier survival curve analysis was also used to analyze the effects of hs-TnI level and GRACE2 .0 score on the short term mortality rate of cardiovascular diseases .Results In this study ,the average value of hs-TnI level in the death group was (7 .5 ± 5 .6)μg/L ,which was significantly higher than (1 .2 ± 2 .9)μg/L in the survival group (P<0 .01) .The short term cardiovascular morality rate in ACS patients was positively cor-related with the hs-TnI level (P<0 .01) .The effect of hs-TnI level on short term cardiovascular morality rate in ACS patients was analyzed by the Kapian-Meier survival curve ,the patients with hs-TnI >0 .014 μg/L had significantly poor short term prognosis (Log rank 62 .81 ,P<0 .01);the GRACE2 .0 score showed positive correlation with the 30 d cardiovascular morality in ACS pa-tients(P<0 .01) ,the short term survival rate in the patients with extremely high risk ACS was significantly decreased (Log rank 116.56,P<0.001).Buttheareaunderthesurvivalcurve(AUC)ofhs-TnIwas0.079(95% CI:0.75-0.83,P<0.01),andAUCof GRACE2 .0 score was 0 .81(95% CI:0 .79-0 .84 ,P<0 .01) .In the comparison between them ,the predictive value of GRACE2 .0 risk score was slightly higher than that of hs-TnI .Therefore ,the combination of hs-TnI and GRACE risk score could increase the value for predicting recent cardiovascular morality in ACS patients [AUC=0 .84(0 .81-0 .91)] .Conclusion hs-TnI combined with GRACE2 .0 score has an important prediction value in short term cardiovascular death risk in ACS patients .