Synetos Andreas, Georgiopoulos George, Pylarinou Voula, Toutouzas Konstantinos, Maniou Katerina, Drakopoulou Maria, Tolis Panagiotis, Karanasos Antonios, Papanikolaou Aggelos, Latsios George, Tsiamis Eleftherios, Tousoulis Dimitrios
First Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece.
First Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece.
Int J Cardiol. 2017 Mar 1;230:482-487. doi: 10.1016/j.ijcard.2016.12.078. Epub 2016 Dec 24.
The aim of this study was to compare the predictive ability of clinical risk scores (ACEF, EuroSCORE and EuroSCORE II) to angiographic (SYNTAX score) and combined risk scores (Global Risk Score and Clinical SXscore) towards cardiovascular death and/or major adverse cardiac events (MACE) in patients with ST-segment elevation acute myocardial infarction (STEMI) managed with primary percutaneous coronary intervention (pPCI).
A total of 685 patients successfully treated with pPCI were evaluated and the risk scores were calculated. The primary endpoint was the 2-year incidence of fatal cardiac events. Secondary end points were target lesion failure (TLF), repeat revascularization (RR) and MACE.
Patients distributed in the highest tertile of EuroSCORE II presented increased rates of CV death (CVD), all-cause mortality and MACE (p<0.001 for all). EuroSCORE II was associated with increased C-statistics (0.873, 95% CIs: 0.784-0.962 and 0.825, 95% CIs: 0.752-0.898 respectively) for predicting CVD and MACE over competing risk scores (p<0.05). EuroSCORE II conferred incremental discrimination (Harrell's C, p<0.05 for all, apart from CSS for predicting CVD) and reclassification value (Net Reclassification Index, p<0.05 for all, apart from CSS for reclassifying MACE) over alternative risk scores for study's main endpoints. EuroSCORE II independently predicted CVD (HR=1.06, 95% CIs: 1.03-1.09, p<0.001) and MACE (HR=1.07, 95% CIs: 1.04-1.10, p<0.001).
EuroSCORE II has the best predictive ability of CVD and/or MACE after successful pPCI for the treatment of STEMI.
本研究旨在比较临床风险评分（ACEF、欧洲心脏手术风险评估系统和欧洲心脏手术风险评估系统II）、血管造影风险评分（SYNTAX评分）以及综合风险评分（全球风险评分和临床SYNTAX评分）对接受直接经皮冠状动脉介入治疗（pPCI）的ST段抬高型急性心肌梗死（STEMI）患者心血管死亡和/或主要不良心脏事件（MACE）的预测能力。
对总共685例成功接受pPCI治疗的患者进行评估并计算风险评分。主要终点为2年内心脏性死亡事件的发生率。次要终点为靶病变失败（TLF）、再次血运重建（RR）和MACE。
欧洲心脏手术风险评估系统II处于最高三分位数的患者发生心血管死亡（CVD）、全因死亡率和MACE的比率升高（所有p<0.001）。与竞争风险评分相比，欧洲心脏手术风险评估系统II在预测CVD和MACE方面具有更高的C统计量（分别为0.873，95%可信区间：0.784 - 0.962和0.825，95%可信区间： 0.752 - 0.898）（p<0.05）。对于研究的主要终点，与其他风险评分相比，欧洲心脏手术风险评估系统II具有更高的鉴别能力（Harrell's C，除预测CVD的CSS外，所有p<0.05）和重新分类价值（净重新分类指数，除重新分类MACE的CSS外，所有p<0.05）。欧洲心脏手术风险评估系统II独立预测CVD（风险比=1.06，95%可信区间：1.03 - 1.09，p<0.001）和MACE（风险比=1.07，95%可信区间：1.04 - 1.10，p<0.001）。
对于STEMI患者成功进行pPCI治疗后，欧洲心脏手术风险评估系统II对CVD和/或MACE具有最佳预测能力。
