Validation of CHADS2 score in patients with acute ST-elevation myocardial infarction
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摘要: 目的:探索CHADS2评分在急性ST段抬高型心肌梗死 (STEMI) 患者长期预后评价中的应用价值。方法:回顾性收集医院病历库2015-01-2018-12连续住院的急性STEMI患者临床及随访资料。主要终点为复合心血管事件 (包含全因死亡、非致死性心肌梗死、脑梗死、心力衰竭和不稳定型心绞痛) ;次要终点为全因死亡、非致死性心脑血管事件和非心脑血管事件等。采用Cox回归评价CHADS2评分与终点事件的相关性。结果:共纳入570例连续STEMI患者, 平均年龄 (58.9±13.7) 岁, 男性占83.3%, TIMI风险评分低危、中危和高危患者分别为279、178和113例。在共619.7人年的随访中, 发生主要终点事件102例, 全因死亡46例, 非致死性心脑血管事件56例。Cox回归分析提示CHADS2评分与主要终点事件[HR:1.331 (1.111~1.593, P<0.001) ]和非致死性心脑血管事件[HR:1.647 (1.345~2.017) , P<0.001]独立相关, 与全因死亡和非心脑血管事件无显著相关。ROC提示CHADS2评分在主要终点事件预测方面与TIMI评分相当, 在全因死亡的预测方面不如TIMI评分, 在非致死性心脑血管事件的预测方面优于TIMI评分。结论:CHADS2评分可用于STEMI患者的再发心脑血管事件风险评估。Abstract: Objective:Considerable variability in the major cardiovascular events risk exists among patients with ST-elevation myocardial infarction (STEMI) .The aim of this study is to validate the contribution of CHADS2 score in the long-term prognosis of patients with STEMI.Method:We retrospectively retrieved consecutive hospitalized patients due to acute STEMI between January 2015 and December 2018 from the Electronic Medical Record library.The clinical and follow-up data were collected.The primary endpoint was the major adverse composite cardiovascular events (MACCEs) of all-cause death, nonfatal myocardial infarction, stroke, heart failure and unstable angina pectoris, and the secondary endpoints were all-cause death, nonfatal cardiovascular events and non-cardiovascular events.Cox regression model was used to evaluate the correlation between CHADS2 score at admission and the primary and the secondary endpoint events.Result:A total of 570 patients were included, aged 58.9±13.7 years old, 83.3% were males.The TIMI risk score showed that patients with low (0-3 points) , middle (4-6 points) and high (7-14 points) risk were 279, 178 and 113 cases, respectively.In a total follow-up period of 619.7 patient-years, 139 major adverse events occurred, including 102 cases of the MACCEs, 46 cases of all-cause death and 56 cases of non-fatal cardiovascular events.Cox regression analysis suggests that CHADS2 score was independently correlated with the MACCEs[HR:1.331 (1.111-1.593, P<0.001) ]and non-fatal cardiovascular events[HR:1.647 (1.345-2.017) , P<0.001], but not correlated with all-cause death.ROC suggested that the prognosis of CHADS2 score was not inferior to the TIMI score in the MACCEs, and not better than the TIMI score in allcause death, but better than the TIMI score in the non-fatal cardiovascular events.Conclusion:The CHADS2 score can effectively predict the risk of re-incidence of adverse cardiovascular events in patients with STEMI.
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