JCSA风险评分系统对中国变异型心绞痛患者的预后评估

江耀辉; 王喆; 郑汝杰; 贾雨晨; 桑海强

doi:10.13201/j.issn.1001-1439.2020.09.009

JCSA风险评分系统对中国变异型心绞痛患者的预后评估

- 郑州大学第一附属医院心血管内科(郑州, 450001)

详细信息

通讯作者: 桑海强,E-mail:shq669@126.com

中图分类号: R541.4

收稿日期: 2020-01-15

Prognosis evaluation of Chinese variant angina patients by JCSA risk score

- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450001, China

More Information

Corresponding author: SANG Haiqiang, E-mail: shq669@126.com

Received Date: 15 January 2020

摘要

摘要: 目的:探讨日本冠状动脉痉挛协会(JCSA)风险评分系统对中国变异型心绞痛患者危险分层及不良预后的预测作用。方法:回顾性分析郑州大学第一附属医院2010年12月-2019年6月收治入院的变异型心绞痛患者的临床资料,根据患者有无院外心脏骤停史、吸烟、静息心绞痛、器质性冠状动脉(冠脉)狭窄、多支血管痉挛、心绞痛期间ST段抬高和β-受体阻滞剂使用情况,用JCSA风险评分系统对变异型心绞痛患者进行评分分层,观察并记录主要不良心血管事件(MACE)发生例数。结果:总共筛选出200例患者,189例纳入研究,其中低危组0例,中危组115例,高危组74例,平均随访(24±23)个月,失访4例(3例高危,1例中危)。其中中危组MACE发生率为7.01%(8例次);高危组MACE发生率为14.1%(10例次);中危组和高危组人群分别与JCSA研究的人群的MACE数进行比较,差异无统计学意义(χ²=0.000 09,P=0.992;χ²=0.051,P=0.822)。结论:JCSA风险评分系统可以作为一个有效的预测工具为变异型心绞痛患者提供全面的风险评估和预后分层,可以通过控制相关危险因素改善患者预后。
- JCSA风险评分系统 /
- 变异型心绞痛 /
- 预后
Abstract: Objective:To explore prognosis of Chinese variant angina(VA) patients by JCSA risk score(Japanese Coronary Spasm Association risk score,JCSA risk score).Method:After retrospective screening of all consecutive VA patients in the First Affiliated Hospital of Zhengzhou University from December 2010 to June 2019,all patients were graded by JCSA risk score according to the history of out-of-hospital cardiac arrest,smoking,resting angina pectoris,organic coronary artery stenosis,multi-vessel spasm,ST-segment elevation during angina pectoris and the use of beta-blockers.The main adverse cardiovascular events(MACE) were observed including cardiogenic death,non-fatal myocardial infarction,readmission due to angina attack and heart failure.Result:A total of 200 VA patients were screened and 189 of them were included in this study.Low risk group:0 cases;Middle risk group:115 cases;High risk group:74 cases.Following up for(24±23) months but 4 cases(3 high-risk cases,1 middle-risk case) were lost to follow-up.The number of MACEs in low-risk group,middle-risk group and high-risk group was 0,8(7.01%) and 10(14.1%) respectively.There was no significant difference in the number of MACEs in the middle risk group and the high risk group between our study and Japanese study(χ²=0.000 09,P=0.992;χ²=0.051,P=0.822).Conclusion:JCSA risk score system can be used as an effective predictive tool to provide comprehensive risk assessment and prognostic stratification for VA patients.We can improve the prognosis of patients by controlling predictive factors.
- JCSA risk score /
- variant angina pectoris /
- prognosis

HTML全文

参考文献(31)

[1]	JCS Joint Working Group.Guidelines for diagnosis and treatment of patients with vasospastic angina (Coronary Spastic Angina) (JCS 2013)[J].Circ J,2014,78(11):2779-2801.
[2]	Knuuti J,Wijns W,Saraste A,et al.2019 ESC Guidelines on the diagnosis and management of chronic coronary syndromes[J].Eur Heart J,2020,41(3):407-477.
[3]	向定成,曾定尹,霍勇.冠状动脉痉挛综合征诊断与治疗中国专家共识[J].中国介入心脏病学杂志,2015,23(4):181-186.
[4]	Takagi Y,Takahashi J,Yasuda S,et al.Prognostic stratification of patients with vasospastic angina:a comprehensive clinical risk score developed by the Japanese Coronary Spasm Association[J].J Am Coll Cardiol,2013,62(13):1144-1153.
[5]	赵培,陶金,袁晓晨,等.冠心病患者PCI术后长期高剂量阿托伐他汀治疗的疗效及安全性[J].临床心血管病杂志,2017,33(3):226-230.
[6]	曾秋棠,彭昱东.急性冠脉综合征和冠脉支架患者的抗血小板优化治疗[J].临床心血管病杂志,2018,34(5):437-440.
[7]	Wang X,Zhang L,Gao C,et al.ST-segment elevation and the Tpeak-Tend/QT ratio predict the occurrence of malignant arrhythmia events in patients with vasospastic angina[J].J Electrocardiol,2019,53:52-56.
[8]	周生辉,缪黄泰,聂绍平.血管痉挛性心绞痛诊断与治疗研究进展[J].临床心血管病杂志,2017,33(4):304-308.
[9]	Choi BG,Rha SW,Park T,et al.Impact of cigarette smoking:a 3-year clinical outcome of Vasospastic angina patients[J].Korean Circ J,2016,46(5):632-638.
[10]	Kim M,Park JH,Lee JH,et al.Comparison of long-term clinical outcomes of percutaneous coronary intervention in vasospastic angina patients associated with significant coronary artery stenosis[J].Int J Cardiol,2016,218:75-78.
[11]	Chatzizisis YS,Coskun AU,Jonas M,et al.Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling:molecular,cellular,and vascular behavior[J].J Am Coll Cardiol,2007,49(25):2379-2393.
[12]	Shin ES,Her AY,Ann SH,et al.Thrombus and plaque erosion characterized by optical coherence tomography in patients with vasospastic angina[J].Rev Esp Cardiol (Engl Ed),2017,70(6):459-466.
[13]	Ong P,Athanasiadis A,Hill S,et al.Coronary artery spasm as a frequent cause of acute coronary syndrome:The CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) Study[J].J Am Coll Cardiol,2008,52(7):523-527.
[14]	Ong P,Athanasiadis A,Borgulya G,et al.3-year follow-up of patients with coronary artery spasm as cause of acute coronary syndrome:the CASPAR (coronary artery spasm in patients with acute coronary syndrome) study follow-up[J].J Am Coll Cardiol,2011,57(2):147-152.
[15]	Takatsu F,Watarai M.Mild stenosis makes prognosis of vasospastic angina worse[J].Coron Artery Dis,2011,22(1):1-5.
[16]	Lanza GA,Sestito A,Sgueglia GA,et al.Current clinical features,diagnostic assessment and prognostic determinants of patients with variant angina[J].Int J Cardiol,2007,118(1):41-47.
[17]	Han SH,Lee KY,Her SH,et al.Impact of multi-vessel vasospastic angina on cardiovascular outcome[J].Atherosclerosis,2019,281:107-113.
[18]	Iranirad L,Sadeghi MS.A rare case of spontaneous and simultaneous multivessel coronary artery spasm leading to multisite myocardial infarction and ventricular fibrillation[J].ARYA Atheroscler,2018,14(1):41-43.
[19]	Park SH,Choi BG,Rha SW,et al.The multi-vessel and diffuse coronary spasm is a risk factor for persistent angina in patients received anti-angina medication[J].Medicine (Baltimore),2018,97(47):e13288.
[20]	Takagi Y,Yasuda S,Tsunoda R,et al.Clinical characteristics and long-term prognosis of vasospastic angina patients who survived out-of-hospital cardiac arrest:multicenter registry study of the Japanese Coronary Spasm Association[J].Circ Arrhythm Electrophysiol,2011,4(3):295-302.
[21]	Park TK,Gwag HB,Park SJ,et al.Differential prognosis of vasospastic angina according to presentation with sudden cardiac arrest or not:Analysis of the Korean Health Insurance Review and Assessment Service[J].Int J Cardiol,2018,273:39-43.
[22]	Ozyüncü N,Goksülük H,Vurgun VK,et al.Stent and implantable cardioverter defibrillator implantation in medically resistant vasospastic angina patient[J].Turk Kardiyol Dern Ars,2017,45(7):641-645.
[23]	Klein SL,Flanagan KL.Sex differences in immune responses[J].Nat Rev Immunol,2016,16(10):626-638.
[24]	Straub RH.The complex role of estrogens in inflammation[J].Endocr Rev,2007,28(5):521-574.
[25]	Amaya-Amaya J,Montoya-Sánchez L,Rojas-Villarraga A.Cardiovascular involvement in autoimmune diseases[J].Biomed Res Int,2014,2014:367359.
[26]	Kimura E,Kishida H.Treatment of variant angina with drugs:a survey of 11 cardiology institutes in Japan[J].Clirculation,1981,63:844-848.
[27]	Oh MS,Yang JH,Lee DH,et al.Impact of statin therapy on long-term clinical outcomes of vasospastic angina without significant stenosis:A propensity-score matched analysis[J].Int J Cardiol,2016,223:791-796.
[28]	Choi BG,Jeon SY,Rha SW,et al.Impact of renin-angiotensin system inhibitors on long-term clinical outcomes of patients with coronary artery spasm[J].J Am Heart Assoc,2016,5(7).e003217.
[29]	Ishii M,Kaikita K,Sato K,et al.Impact of aspirin on the prognosis in patients with coronary spasm without significant atherosclerotic stenosis[J].Int J Cardiol,2016,220:328-332.
[30]	黄浙勇,钱菊英,杨虹波,等.药物洗脱支架治疗血管痉固定性狭窄的疗效[J].中华心血管病杂志,2012,40(7):560-564.
[31]	Ishii M,Kaikita K,Sato K,et al.Acetylcholine-provoked coronary spasm at site of significant organic stenosis predicts poor prognosis in patients with coronary vasospastic angina[J].J Am Coll Cardiol,2015,66(10):1105-1115.