Chen Xiao-Hui, Jiang Hui-Lin, Li Yun-Mei, Chan Cangel Pui Yee, Mo Jun-Rong, Tian Chao-Wei, Lin Pei-Yi, Graham Colin A, Rainer Timothy H
Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
Medicine (Baltimore). 2016 Dec;95(52):e4778. doi: 10.1097/MD.0000000000004778.
Four risk scores for stratifying patients with chest pain presenting to emergency departments (EDs) (namely Thrombolysis in myocardial infarction [TIMI], Global registry for acute coronary events [GRACE], Banach and HEART) have been developed in Western settings but have never been compared and validated in Chinese patients. We aimed to find out to the number of MACE within 7 days, 30 days, and 6 months after initial ED presentation, and also to compare the prognostic performance of these scores in Chinese patients with suspected cardiac chest pain (CCP) to predict 7-day, 30-day, and 6-month major adverse cardiac events (MACE).A prospective 2-center observational cohort study of consecutive patients presenting with chest pain to the EDs of 2 university hospitals in Guangdong and Hong Kong from 17 March 2012 to 14 August 2013 was conducted. Patients aged ≥18 years with suspected CCP but without ST-segment elevation myocardial infarction (STEMI) were recruited.Of 833 enrolled patients (mean age 65.1 years, SD14.5; 55.6% males), 121 (14.5%) experienced MACE within 6 months (4.8% with safety outcomes and 10.3% with effectiveness outcomes). The HEART score had the largest area under the receiver operating characteristic (ROC) curve for predicting MACE at 7-day, 30-day, and 6-month follow-up [area under curve (AUC) = 0.731, 0.726, and 0.747, respectively. The HEART score also had the largest AUC for predicting effectiveness outcome (AUC = 0.715, 0.704, and 0.721, respectively). However, there was no significant difference in AUC between HEART and TIMI scores. Banach had the largest AUC for predicting safety outcome (AUC = 0.856, 0.837, and 0.850, respectively).The HEART score performed better than the GRACE and Banach scores to predict total MACE and effectiveness outcome in Chinese patients with suspected CCP, whereas the Banach score best predicted safety outcomes.
用于对前往急诊科就诊的胸痛患者进行分层的四个风险评分（即心肌梗死溶栓治疗 [TIMI]、急性冠状动脉事件全球注册 [GRACE]、巴纳赫评分和 HEART 评分）已在西方背景下开发出来，但从未在中国患者中进行过比较和验证。我们旨在找出初次到急诊科就诊后 7 天、30 天和 6 个月内发生主要不良心血管事件（MACE）的数量，并比较这些评分在中国疑似心脏性胸痛（CCP）患者中预测 7 天、30 天和 6 个月 MACE 的预后性能。
对 2012 年 3 月 17 日至 2013 年 8 月 14 日期间在广东和香港的 2 所大学医院急诊科连续就诊的胸痛患者进行了一项前瞻性 2 中心观察性队列研究。招募年龄≥18 岁、疑似 CCP 但无 ST 段抬高型心肌梗死（STEMI）的患者。
在 833 名入组患者中（平均年龄 65.1 岁，标准差 14.5；55.6%为男性），121 名（14.5%）在 6 个月内发生了 MACE（4.8%为安全性结局，10.3%为有效性结局）。在预测 7 天、30 天和 6 个月随访时的 MACE 方面，HEART 评分在受试者工作特征（ROC）曲线下的面积最大[曲线下面积（AUC）分别为 0.731、0.726 和 0.747]。HEART 评分在预测有效性结局方面的 AUC 也最大（分别为 0.715、0.704 和 0.721）。然而，HEART 评分和 TIMI 评分之间的 AUC 没有显著差异。巴纳赫评分在预测安全性结局方面的 AUC 最大（分别为 0.856、0.837 和 0.850）。
在预测中国疑似 CCP 患者的总 MACE 和有效性结局方面，HEART 评分的表现优于 GRACE 评分和巴纳赫评分，而巴纳赫评分在预测安全性结局方面表现最佳。
