CAJ | 학술논문

目的比较临床风险积分、心肌梗死溶栓试验(TIMI)血流分级以及联合应用临床风险积分和TIMI血流分级(简称:联合风险积分)对急性冠状动脉综合征(ACS)预后的评估价值.方法选择2004年12月至2006年6月在本院住院并接受冠状动脉造影或支架置入的ACS患者,分别用临床风险积分、TIMI血流分级和联合风险积分进行预后评估.以心原性死亡和非心原性死亡为一级终点;以非致命性卒中、心力衰竭、再发心肌梗死和心绞痛为二级终点.绘制受试者工作特性曲线(ROC),比较这3种方法的预后评估价值.结果入选ACS患者206例,失访11例(5.34%).平均年龄(67.57±9.88)岁,男性135例(69.2%).平均随访(11.41±5.33)个月,8例达到一级终点,17例达到二级终点.临床风险积分、TIMI血流分级和联合风险积分较好拟合本组患者总事件和一级终点的分布.对总事件的评估:临床风险积分曲线下面积(AUC)=0.67,P=0.006;TIMI血流分级AUC=0.68,P=0.004;联合风险积分AUC=0.73,P＜0.001.经配对比较,发现临床风险积分与TIMI血流分级、TIMI血流分级与联合风险积分和临床风险积分与联合风险积分之间差异无统计学意义;对一级终点的评估,临床风险积分AUC=0.54,P=0.19;TIMI血流分级AUC:0.73,P=0.028;联合风险积分AUC=0.76,P=0.014.经配对比较,P值分别是0.451、0.784和0.204.对二级终点的评估,临床风险积分AUC=0.67,P=0.018;TIMI血流分级AUC=0.64,P=0.052;联合风险积分AUC=0.69,P=0.009.经配对比较,P值依次是0.734、0.470和0.667.三种方法对一、二级终点的评估价值差异均无统计学意义.结论临床风险积分、TIMI血流分级和联合风险积分对ACS总事件评估价值相似.联合风险积分不仅对总事件评估有预测价值,而且对一级终点和二级终点也有预测价值.
목적 비교림상풍험적분、심기경사용전시험(TIMI)혈류분급이급연합응용림상풍험적분화TIMI혈류분급(간칭:연합풍험적분)대급성관상동맥종합정(ACS)예후적평고개치.방법 선택2004년12월지2006년6월재본원주원병접수관상동맥조영혹지가치입적ACS환자,분별용림상풍험적분、TIMI혈류분급화연합풍험적분진행예후평고.이심원성사망화비심원성사망위일급종점;이비치명성졸중、심력쇠갈、재발심기경사화심교통위이급종점.회제수시자공작특성곡선(ROC),비교저3충방법적예후평고개치.결과 입선ACS환자206례,실방11례(5.34%).평균년령(67.57±9.88)세,남성135례(69.2%).평균수방(11.41±5.33)개월,8례체도일급종점,17례체도이급종점.림상풍험적분、TIMI혈류분급화연합풍험적분교호의합본조환자총사건화일급종점적분포.대총사건적평고:림상풍험적분곡선하면적(AUC)=0.67,P=0.006;TIMI혈류분급AUC=0.68,P=0.004;연합풍험적분AUC=0.73,P＜0.001.경배대비교,발현림상풍험적분여TIMI혈류분급、TIMI혈류분급여연합풍험적분화림상풍험적분여연합풍험적분지간차이무통계학의의;대일급종점적평고,림상풍험적분AUC=0.54,P=0.19;TIMI혈류분급AUC:0.73,P=0.028;연합풍험적분AUC=0.76,P=0.014.경배대비교,P치분별시0.451、0.784화0.204.대이급종점적평고,림상풍험적분AUC=0.67,P=0.018;TIMI혈류분급AUC=0.64,P=0.052;연합풍험적분AUC=0.69,P=0.009.경배대비교,P치의차시0.734、0.470화0.667.삼충방법대일、이급종점적평고개치차이균무통계학의의.결론 림상풍험적분、TIMI혈류분급화연합풍험적분대ACS총사건평고개치상사.연합풍험적분불부대총사건평고유예측개치,이차대일급종점화이급종점야유예측개치.
Objective To compare the prognostic value of clinical risk score and thrombolysis in myocardial infarction(TIMI)flow grade alone or combined on outcome of acute coronary syndrome(ACS).Methods A total of 206 eligible patients [135 males,mean age(67.57±9.88)years]were enrolled.The primary endpoints included cardiac death and non-cardiac death.The score,TIMI flow grade and combined risk score(all P＞0.05)for AUC and for primary end point and the secondary end point.Conclusion The result from this study suggests that the efficacy of predicting the total events based on clinical risk score,TIMI flow grade and combined risk score was similar.secondary endpoints included non-fatal stroke,reinfarction,heart failure and recurrent angiha.Receiver operating characteristic curve(ROC) established by using different endpoints and clinical risk score,TIMI flow grade or combined risk scores.The prognostic value for different endpoint expressed as the area under the curve(AUC).Results Eleven patients lost during the(11.41±5.33)months follow up and data were available for 195 patients,8 patients reached the primary endpoints,and 17 patients reached the secondary end-points at the end of follow up.The AUC was 0.67(95% CI=0.557～0.786),P=0.006;0.68(95% CI,=0.557～0.786),P=0.004 and 0.730(95% CI=0.691～0.815),P＜0.001,respectively for clinical risk score,TIMI flow grade and the combined risk score respectively.There were no significant differences among clinical risk score,TIMI flow grade and combined risk(all P>0.05)for ACU and for primaty end point and the secondary end point. Conclusion The result from this study suggests that the eppicacy of predicting the total events based on clinical risk score,TIMI flow grade and combined risk score was similar.