验证 5 种风险评分在经皮冠状动脉介入治疗后实现完全血运重建的患者中主要不良心脏事件的表现。
Validating the Performance of 5 Risk Scores for Major Adverse Cardiac Events in Patients Who Achieved Complete Revascularization After Percutaneous Coronary Intervention.
机构信息
State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
出版信息
Can J Cardiol. 2019 Aug;35(8):1058-1068. doi: 10.1016/j.cjca.2019.02.017. Epub 2019 Feb 27.
BACKGROUND
Risk scores, like the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (SS), clinical SS, logistic SS (core model and extended model [LSS]), Age, Creatinine, and Ejection Fraction (ACEF) score, and modified ACEF score, are predictive for major adverse cardiac events (MACE; including all-cause mortality, myocardial infarction [MI], and revascularization) in patients who have undergone percutaneous coronary intervention (PCI). However, few studies have validated the performance of these scores in complete revascularization (CR) patients. We aimed to compare the performance of previous risk scores in patients who achieved CR after PCI.
METHODS
All patients (N = 10,724) who underwent PCI at Fuwai Hospital in 2013 were screened, and those who achieved CR after PCI were enrolled. Risk scores were calculated by experienced cardiologists blinded to the clinical outcomes. Discrimination of risk scores was assessed according to the area under the receiver operating characteristic curve (AUC).
RESULTS
Fifty-one percent (5375/10,724) of patients who underwent PCI achieved CR. At a mean follow-up of 2.4 years, the mortality, MI, revascularization, and MACE rates were 1.2%, 1.0%, 6.3%, and 7.7%, respectively. SS was not predictive for mortality (AUC, 0.51; 95% confidence interval [CI], 0.44-0.59). All scores involving clinical variables, especially modified ACEF score (AUC, 0.73; 95% CI, 0.66-0.79), could predict mortality. LSS was the most accurate for MI (AUC, 0.68; 95% CI, 0.61-0.75). SS and LSS were predictive for revascularization, with marginally significant AUCs (SS, 0.54; LSS, 0.55). No score was particularly accurate for predicting MACE, with AUCs ranging from 0.51 (ACEF score) to 0.58 (LSS).
CONCLUSIONS
In CR patients, risk scores involving clinical variables might help to predict mortality; however, no risk scores showed helpful discrimination for MACE.
背景
风险评分，如经皮冠状动脉介入治疗与紫杉醇的协同作用（SYNTAX）评分（SS）、临床 SS、逻辑 SS（核心模型和扩展模型[LSS]）、年龄、肌酐和射血分数（ACEF）评分和改良 ACEF 评分，可预测接受经皮冠状动脉介入治疗（PCI）的患者发生主要不良心脏事件（MACE；包括全因死亡率、心肌梗死[MI]和血运重建）。然而，很少有研究验证这些评分在完全血运重建（CR）患者中的表现。我们旨在比较 PCI 后达到 CR 的患者中先前风险评分的表现。
方法
筛选 2013 年在阜外医院接受 PCI 的所有患者（N=10724），并纳入 PCI 后达到 CR 的患者。风险评分由经验丰富的心脏病专家在不了解临床结果的情况下计算。根据接受者操作特征曲线（ROC）下面积评估风险评分的区分能力。
结果
51%（5375/10724）接受 PCI 的患者达到 CR。平均随访 2.4 年后，死亡率、MI、血运重建和 MACE 发生率分别为 1.2%、1.0%、6.3%和 7.7%。SS 不能预测死亡率（AUC，0.51；95%置信区间[CI]，0.44-0.59）。所有涉及临床变量的评分，尤其是改良 ACEF 评分（AUC，0.73；95%CI，0.66-0.79），均可预测死亡率。LSS 对 MI 最准确（AUC，0.68；95%CI，0.61-0.75）。SS 和 LSS 可预测血运重建，AUC 略有显著差异（SS，0.54；LSS，0.55）。没有评分对预测 MACE 特别准确，AUC 范围为 0.51（ACEF 评分）至 0.58（LSS）。
结论
在 CR 患者中，涉及临床变量的风险评分可能有助于预测死亡率；然而，没有风险评分对 MACE 具有有帮助的区分能力。
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