Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Am J Cardiol. 2012 Feb 1;109(3):307-13. doi: 10.1016/j.amjcard.2011.09.014. Epub 2011 Nov 8.
Risk assessment is central to the management of acute coronary syndromes. Often, however, assessment is not complete until the troponin concentration is available. Using 2 multicenter prospective observational studies (Evaluation of Methods and Management of Acute Coronary Events [EMMACE] 2, test cohort, 1,843 patients; and EMMACE-1, validation cohort, 550 patients) of unselected patients with acute coronary syndromes, a point-of-admission risk stratification tool using frontal QRS-T angle derived from automated measurements and age for the prediction of 30-day and 2-year mortality was evaluated. Two-year mortality was lowest in patients with frontal QRS-T angles <38° and highest in patients with frontal QRS-T angles >104° (44.7% vs 14.8%, p <0.001). Increasing frontal QRS-T angle-age risk (FAAR) scores were associated with increasing 30-day and 2-year mortality (for 2-year mortality, score 0 = 3.7%, score 4 = 57%; p <0.001). The FAAR score was a good discriminator of mortality (C statistics 0.74 [95% confidence interval 0.71 to 0.78] at 30 days and 0.77 [95% confidence interval 0.75 to 0.79] at 2 years), maintained its performance in the EMMACE-1 cohort at 30 days (C statistics 0.76 (95% confidence interval 0.71 to 0.8] at 30 days and 0.79 (95% confidence interval 0.75 to 0.83] at 2 years), in men and women, in ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, and compared favorably with the Global Registry of Acute Coronary Events (GRACE) score. The integrated discrimination improvement (age to FAAR score at 30 days and at 2 years in EMMACE-1 and EMMACE-2) was p <0.001. In conclusion, the FAAR score is a point-of-admission risk tool that predicts 30-day and 2-year mortality from 2 variables across a spectrum of patients with acute coronary syndromes. It does not require the results of biomarker assays or rely on the subjective interpretation of electrocardiograms.
风险评估是急性冠状动脉综合征管理的核心。然而，通常要等到肌钙蛋白浓度可用时才能完成评估。本研究使用 2 项多中心前瞻性观察性研究（急性冠状动脉事件的方法和管理评估[EMMACE]2 试验队列，1843 例患者；和 EMMACE-1 验证队列，550 例患者），评估了一种基于自动测量和年龄的入院时风险分层工具，该工具使用额面 QRS-T 角预测 30 天和 2 年死亡率。结果显示，急性冠状动脉综合征患者中，额面 QRS-T 角＜38°患者的 2 年死亡率最低（44.7%比 14.8%，p＜0.001），额面 QRS-T 角＞104°患者的 2 年死亡率最高。额面 QRS-T 角-年龄风险（FAAR）评分与 30 天和 2 年死亡率的增加相关（2 年死亡率评分 0=3.7%，评分 4=57%，p＜0.001）。FAAR 评分是死亡率的良好判别指标（30 天的 C 统计量为 0.74[95%置信区间 0.71 至 0.78]，2 年的 C 统计量为 0.77[95%置信区间 0.75 至 0.79]），在 EMMACE-1 队列中 30 天的表现也很稳定（30 天的 C 统计量为 0.76[95%置信区间 0.71 至 0.8]，2 年的 C 统计量为 0.79[95%置信区间 0.75 至 0.83]），在男性和女性、ST 段抬高型心肌梗死和非 ST 段抬高型心肌梗死患者中表现一致，优于全球急性冠状动脉事件注册（GRACE）评分。30 天和 2 年的整合判别改善（EMMACE-1 和 EMMACE-2 中的年龄到 FAAR 评分）均为 p＜0.001。综上所述，FAAR 评分是一种入院时风险工具，可通过 2 个变量预测急性冠状动脉综合征患者的 30 天和 2 年死亡率，它不需要生物标志物检测结果，也不依赖于心电图的主观解释。
