Ma C P, Liu X L, Wang Q S, Nie S P
Department of Cardiology, First Hospital of Qinhuangdao, Hebei Medical University, Qinhuangdao 066000, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2018 Feb 24;46(2):131-136. doi: 10.3760/cma.j.issn.0253-3758.2018.02.012.
To develop and prospectively validate a risk score for acute chest pain patients with normal high-sensitivity troponin I (hs-TnI) levels and without obvious ST-segment deviation in China. Chest pain patients admitted to the emergency department of Beijing Anzhen Hospital from September 2014 to July 2015 were enrolled. Baseline characteristics of patients met inclusion criteria including normal hs-TnI levels and without obvious ST-segment deviation were included. The endpoint (major adverse cardiovascular events) was a composite of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, and all-cause death within 3 months after initial presentation. Predictors were screened and used to develop the risk score model by logistic regression analysis in a retrospective cohort. Then, the risk score model was evaluated in a prospective validation cohort. The study population of derivation cohort included 1 735 consecutive chest pain patients. Finally, 1 030 eligible patients were enrolled. Multivariate regression analysis defined five independent predictors: male gender (β=0.88); history of chest pain (β value of moderate and high suspicion of coronary heart artery was 2.70 and 3.51 respectively); electrocardiogram (β=0.84); ≥60 years old (β=0.51) and ≥3 risk factors (β=0.85).The range of weighted score was set as 0-13. The area under a receiver operating characteristic (ROC) curve was 0.75 (95% 0.72-0.78) in the final model. Major adverse cardiovascular events rates increased in proportion to score increase (0.01). The internal validity used bootstrap technique showed the same predictor factors as the final model, and its area under a ROC curve was 0.75(95% 0.72-0.78).MACE rates in the low risk group (score 0-3), intermediate risk group (score 4-7), and high risk group (score 8-13) were 1.3% (1/77) ,19.0% (22/116) ,and 42.2% (122/289) in the prospective validation cohort, respectively (0.01). The developed ischemic risk score is feasible for risk stratification of acute chest pain patients with normal hs-TnI and without obvious ST-segment deviation, this score might be helpful to the decision making of treatment and management strategies for these patients.
在中国，开发并前瞻性验证一种针对高敏肌钙蛋白I（hs-TnI）水平正常且无明显ST段偏移的急性胸痛患者的风险评分。纳入2014年9月至2015年7月在北京安贞医院急诊科就诊的胸痛患者。纳入符合入选标准的患者的基线特征，包括hs-TnI水平正常且无明显ST段偏移。终点（主要不良心血管事件）是初次就诊后3个月内急性心肌梗死、经皮冠状动脉介入治疗、冠状动脉旁路移植术和全因死亡的复合事件。通过回顾性队列中的逻辑回归分析筛选预测因素并用于建立风险评分模型。然后，在前瞻性验证队列中评估风险评分模型。推导队列的研究人群包括1735例连续的胸痛患者。最终，纳入1030例符合条件的患者。多因素回归分析确定了五个独立预测因素：男性（β=0.88）；胸痛病史（中度和高度怀疑冠心病的β值分别为2.70和3.51）；心电图（β=0.84）；≥60岁（β=0.51）和≥3个危险因素（β=0.85）。加权评分范围设定为0-13。最终模型中受试者工作特征（ROC）曲线下面积为0.75（95%CI 0.72-0.78）。主要不良心血管事件发生率随评分增加而呈比例增加（P<0.01）。采用自举技术的内部效度显示与最终模型相同的预测因素，其ROC曲线下面积为0.75（95%CI 0.72-0.78）。在前瞻性验证队列中，低风险组（评分0-3）、中风险组（评分4-7）和高风险组（评分8-13）的主要不良心血管事件发生率分别为1.3%（1/77）、19.0%（22/116）和42.2%（122/289）（P<0.01）。所开发的缺血风险评分对于hs-TnI正常且无明显ST段偏移的急性胸痛患者进行风险分层是可行的，该评分可能有助于这些患者治疗和管理策略的决策。
