查尔森合并症指数在急性冠脉综合征风险分层中的应用及对STEMI急诊PCI的启示

Application of Charlson Comorbidity Index in Risk Stratification of Acute Coronary Syndrome and Its Implications for Emergency PCI in STEMI

摘要: 急性冠脉综合征(acute coronary syndrome, ACS)患者常合并糖尿病、慢性肾病、心力衰竭、慢性肺病等慢性疾病。此类基础疾病不仅影响抗栓治疗、造影剂应用和围术期管理，也与患者院内及远期结局有关。查尔森合并症指数(Charlson Comorbidity Index, CCI)是临床研究中常用的共病负担量化指标，已被用于ACS和急性心肌梗死(acute myocardial infarction, AMI)患者的预后评估。现有研究大体提示，CCI升高与院内死亡、主要不良心血管事件及远期死亡风险增加相关；但在GRACE等传统评分基础上加入CCI后能否明显改善预测效能，不同研究结论并不完全一致。与Elixhauser指数、衰弱评估和营养状态评估相比，CCI更简便，便于病历和数据库提取，但对疾病严重程度、机体储备和老年综合征反映不足。对于ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)急诊经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)患者，目前直接研究仍较少，相关认识主要来自ACS总体、AMI总体或高危亚组人群。本文梳理CCI的基本特点及其在ACS和AMI中的应用证据，从死亡率、非致死性终点及增量预测价值等方面分析现有文献的主要结论与争议，并讨论其对STEMI急诊PCI患者风险识别和围术期管理的启示。

Abstract: Patients with ACS often present with a heavy burden of comorbidities, notably diabetes, chronic kidney disease, heart failure, and chronic lung disease. These coexisting conditions can complicate decisions around antithrombotic regimens, contrast media use, and perioperative care, ultimately influencing both in-hospital and long-term outcomes. The Charlson Comorbidity Index (CCI) is a well-established tool for quantifying comorbidity burden and has been tested in prognostic studies of ACS and AMI. Most published data indicate that a rising CCI is linked to greater risks of in-hospital death, major adverse cardiovascular events, and late mortality. However, it remains debated whether adding CCI to conventional scores like GRACE meaningfully improves risk discrimination. Compared with the Elixhauser Comorbidity Index, frailty assessment, and nutritional evaluation, CCI is simpler and easier to obtain from medical records or administrative databases, but it has limitations in reflecting disease severity, physiological reserve, frailty, and malnutrition. Direct evidence in STEMI patients undergoing emergency PCI is sparse; current knowledge largely extrapolates from wider ACS or AMI cohorts and selected high-risk subgroups. This review outlines the key features of CCI, examines its prognostic performance in ACS and AMI, including its associations with mortality, non-fatal outcomes, and incremental prognostic value, and discusses its potential value in risk stratification and perioperative management for STEMI patients treated with emergency PCI.