Amin Amit P, Nathan Sandeep, Vassallo Patricia, Calvin James E
The John H. Stroger Hospital of Cook County (Cook County Hospital), Chicago, Illinois, USA.
Open Cardiovasc Med J. 2009 May 20;3:39-47. doi: 10.2174/1874192400903010039.
To emphasize the importance of troponin in the context of a new score for risk stratifying acute coronary syndromes (ACS) patients. Although troponins have powerful prognostic value, current ACS scores do not fully capitalize this prognostic ability. Here, we weigh troponin status in a multiplicative manner to develop the TRACS score from previously published Rush score risk factors (RRF).
2,866 ACS patients (46.7% troponin positive) from 9 centers comprising the TRACS registry, were randomly split into derivation (n=1,422) and validation (n=1,444) cohorts. In the derivation sample, RRF sum was multiplied by 3 if troponins were positive to yield the TRACS score, which was grouped into five categories of 0-2, 3-5, 6-8, 9-11, 12-15 (multiples of 3). Predictive performance of this score to predict hospital death was ascertained in the validation sample.
The TRACS score had ROC AUC of 0.71 in the validation cohort. Logistic regression, Kaplan-Meier analysis, likelihood-ratio and Bayesian Information Criterion (BIC) test indicated that weighing troponin status with 3 in the TRACS score improved the prediction of mortality. Hosmer-Lemeshow test indicated sound model fit.
We demonstrate that weighing troponin as a multiple of 3 yields robust prognostication of hospital mortality in ACS patients, when used in the context of the TRACS score.
强调肌钙蛋白在急性冠状动脉综合征（ACS）患者风险分层新评分中的重要性。尽管肌钙蛋白具有强大的预后价值，但目前的ACS评分并未充分利用这种预后能力。在此，我们以乘法方式考量肌钙蛋白状态，根据先前发表的拉什评分风险因素（RRF）制定TRACS评分。
来自9个中心的2866例ACS患者（46.7%肌钙蛋白阳性）纳入TRACS注册研究，随机分为推导队列（n = 1422）和验证队列（n = 1444）。在推导样本中，如果肌钙蛋白呈阳性，RRF总和乘以3得出TRACS评分，该评分分为0 - 2、3 - 5、6 - 8、9 - 11、12 - 15（3的倍数）五个类别。在验证样本中确定该评分预测医院死亡的预测性能。
在验证队列中，TRACS评分的ROC曲线下面积（AUC）为0.71。逻辑回归、Kaplan - Meier分析、似然比和贝叶斯信息准则（BIC）检验表明，在TRACS评分中以3考量肌钙蛋白状态可改善死亡率预测。Hosmer - Lemeshow检验表明模型拟合良好。
我们证明，在TRACS评分背景下，将肌钙蛋白乘以3进行考量，可对ACS患者的医院死亡率产生可靠的预后评估。
