Zhong Bin, Liu Zengzhang, Su Li, Lan Xianbin, Chen Yunqing, Ling Zhiyu, Du Huaan, Yin Yuehui
Department of Cardiology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Clin Cardiol. 2009 Aug;32(8):434-8. doi: 10.1002/clc.20494.
Thrombolysis in myocardial infarction (TIMI) flow grade (TFG) was a gold standard for comparison of the various methods of evaluating the efficacy of reperfusion, and risk score was a pragmatic method of risk stratification and evaluation of prognosis for acute coronary syndrome (ACS). However, it is uncertain whether or not the prognostic value of combining risk score and TFG on outcome of acute coronary syndrome could be improved.
A total of 279 consecutive patients with ACS (mean age 67.57 +/- 9.88 years, 69.2% male) admitted to our hospital were enrolled. Clinical risk score, TFG, and combined risk score were calculated. The primary endpoint of this study included cardiac death and noncardiac death; the secondary endpoint included nonfatal stroke, reinfarction, heart failure, and recurrent angina.
During the follow-up of 11.41 +/- 5.33 months, 11 patients reached the primary endpoint, and 23 patients reached the secondary endpoint. The prognostic values evaluated by composite endpoint, primary endpoint, and secondary endpoint were 0.722, 0.685, and 0.721, respectively, for clinical risk score they were 0.774, 0.798, and 0.737, respectively, for TFG they were 0.805, 0.808, and 0.776, respectively, for combined risk score. In pair-wise comparisons of prognostic values, there were no significant differences among these methods, except that the combined risk score can more accurately predict the composite endpoint than the others.
The results suggest that the combined risk score is a simple and efficient method of prediction of composite endpoint.
心肌梗死溶栓治疗（TIMI）血流分级（TFG）是比较各种再灌注疗效评估方法的金标准，风险评分是急性冠状动脉综合征（ACS）风险分层和预后评估的实用方法。然而，联合风险评分和TFG对急性冠状动脉综合征结局的预后价值是否能得到改善尚不确定。
纳入我院收治的279例连续的ACS患者（平均年龄67.57±9.88岁，男性占69.2%）。计算临床风险评分、TFG和联合风险评分。本研究的主要终点包括心源性死亡和非心源性死亡；次要终点包括非致死性卒中、再梗死、心力衰竭和复发性心绞痛。
在11.41±5.33个月的随访期间，11例患者达到主要终点，23例患者达到次要终点。临床风险评分通过复合终点、主要终点和次要终点评估的预后价值分别为0.722、0.685和0.721；TFG分别为0.774、0.798和0.737；联合风险评分分别为0.805、0.808和0.776。在预后价值的两两比较中，这些方法之间无显著差异，除联合风险评分比其他方法能更准确地预测复合终点。
结果表明联合风险评分是预测复合终点的一种简单有效的方法。
