GRACE评分、TIMI评分联合NT-proBNP对急性心肌梗死患者预后的预测作用

GRACE Score and TIMI Score Combined with NT-proBNP on Predicting the Prognosis of Patients with Acute Myocardial Infarction

摘要: 目的：研究目前被广泛推荐的风险评分与心血管生物标志物的组合是否可以更好地预测急性心肌梗死患者的主要心血管不良事件(MACE)的发生。方法：所有入选患者均为2018年10月至2019年10月在青岛大学附属医院急诊科连续治疗，并确诊为急性心肌梗死的患者，对这些纳入患者进行回顾性调查。入院后收集病史、化验多项生化指标及计算风险评分，结局为主要心脏不良事件(MACE)。对患者进行随访，记录并评估MACE的发生率。根据是否发生MACE将患者分为事件组和非事件组，比较基线资料之间的差异，并采用Cox回归评价MACE的独立显著危险因素。绘制接收者操作特性曲线(ROC曲线)，并通过计算ROC曲线下面积(AUC)比较风险评分及其与其他生物标志物联合的预测价值。结果：纳入的399例患者中，MACE发生率为24.6% (n = 98)。通过Cox回归分析可以得出，Ln (NT-proBNP)、GRACE评分和TIMI评分均为MACE的独立预测因素。根据ROC分析Ln (NT-proBNP) (AUC, 0.790; 95% CI, 0.738~0.843; P < 0.001)，GRACE评分(AUC, 0.801; 95% CI, 0.749~0.853; P < 0.001)和TIMI评分(AUC, 0.743; 95% CI, 0.688~0.799; P < 0.001)在预测MACE方面均表现出良好的性能。此外，联合使用时ROC曲线下面积(AUC)显著增加(AUC, 0.854; 95 %CI, 0.824~0.901; P < 0.001)。结论：GRACE和TIMI这两种广泛应用的风险评分在MACE的发生上均有较好的预测能力。而它们与NT-proBNP的联合使用增加了预测的准确性。

Abstract: Aim: To investigate whether the combination of widely recommended risk scores with cardiovascular biomarkers could better predict MACE occurrence in patients with acute myocardial infarction. Methods: Patients diagnosed with acute myocardial infarction who consecutively treated at the Emergency Department of the Affiliated Hospital of Qingdao University from October 2018 to October 2019 were enrolled. Retrospective study was performed among these enrolled patients. The outcome was major adverse cardiac events (MACE). Medical history, multiple laboratory biomarkers and risk scores were collected and calculated after admission. Patients were followed up and the incidence of MACE was assessed. The patients were divided into event group and non-event group according to whether MACE occurred or not, and the differences between baseline data were compared. Cox proportional hazards regression was used to evaluate the independent significant risk factors for MACE. Receiver operating curve (ROC) analysis was performed to analyze the predictive value. Risk scores and their predictive values in combination with other biomarkers were compared by calculating area under receiver operating characteristic curves (AUCs). Results: Among the 399 patients included, the incidence of MACE was 24.6% (n = 98). According to Cox proportional hazards regression analysis, Ln (NT-proBNP), GRACE scoreand TIMI score were all independent predictors of MACE. And according to receiver operating characteristic analysis, Ln (NT-proBNP) (AUC, 0.790; 95% CI, 0.738~0.843; P < 0.001), GRACE score (AUC, 0.801; 95% CI, 0.749~0.853; P < 0.001) and TIMI score (AUC, 0.743; 95% CI, 0.688~0.799; P < 0.001) all exhibited good performance on predicting MACE. In addition, the area under the ROC curve (AUC) increased significantly when they were used in combination (AUC, 0.854; 95% CI, 0.824~0.901; P < 0.001). Conclusions: The current risk scores: GRACE and TIMI all have good predictive value for the occurrence of MACE. While their combined use and combination with NT-proBNP increased the accuracy of the prediction.