ACEF II 评分在一站式杂交冠状动脉血运重建治疗多支血管病变患者中的预测价值。
Predictive value of ACEF II score in patients with multi-vessel coronary artery disease undergoing one-stop hybrid coronary revascularization.
机构信息
Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China.
出版信息
BMC Cardiovasc Disord. 2021 Oct 10;21(1):489. doi: 10.1186/s12872-021-02299-6.
BACKGROUND
We aimed to investigate the predictive value of recently updated ACEF II score on major adverse cardiac and cerebrovascular events (MACCE) in patients with multi-vessel coronary artery disease (MVCAD) undergoing one-stop hybrid coronary revascularization (HCR).
METHODS
Patients with MVCAD undergoing one-stop HCR were retrospectively recruited from March 2018 to September 2020. Several prediction risk models, including ACEF II score, were calculated for each patient. Kaplan-Meier curve was used to evaluate freedom from cardiac death and MACCE survival rates. Differences of prediction performance among risk scores for predicting MACCE were compared by receiver operating characteristic (ROC) curve.
RESULTS
According to the ACEF II score, a total of 120 patients undergoing one-stop HCR were assigned to low-score group (80 cases) and high-score group (40 cases). During the median follow-up time of 18 months, the incidence of MACCE in the low-score group and high-score group were 8.8 % and 37.5 %, respectively (p < 0.001); and the cardiac death rate of the two were 2.5% and 12.5%, respectively (p < 0.05). Moreover, the cumulative freedom from cardiac death (97.5% vs. 86.8, p < 0.05) and MACCE (75.2% vs. 52.8%, p < 0.001) survival rates in the high-score group were significantly lower than in the low-score group. According to the Cox proportional hazards regression, the ACEF II score was an independent prognostic indicator for MACCE with hazards ratio (HR) 2.24, p = 0.003. The ROC curve analysis indicated that the areas under the curve (AUC) of MACCE from the ACEF II score was 0.740 (p < 0.001), while the AUC of MACCE from the SYNTAX score II CABG was 0.621 (p = 0.070) and the AUC from the EuroSCORE II was 0.703 (p < 0.001). Thus, the accurate predictive value of ACEF II score was similar to the EuroSCORE II but much higher than the SYNTAX score II CABG.
CONCLUSIONS
The updated ACEF II score is a more convenient and validated prediction tool for MACCE in patients with MVCAD undergoing one-stop HCR comparing to other risk models.
背景
本研究旨在探讨更新后的 ACEF II 评分对接受一站式杂交冠状动脉血运重建（HCR）的多支血管冠状动脉疾病（MVCAD）患者主要不良心脑血管事件（MACCE）的预测价值。
方法
回顾性分析 2018 年 3 月至 2020 年 9 月期间接受一站式 HCR 的 MVCAD 患者。为每位患者计算了包括 ACEF II 评分在内的多个预测风险模型。采用 Kaplan-Meier 曲线评估心脏死亡和 MACCE 生存率。通过接收者操作特征（ROC）曲线比较风险评分预测 MACCE 的预测性能差异。
结果
根据 ACEF II 评分，共有 120 例接受一站式 HCR 的患者被分为低评分组（80 例）和高评分组（40 例）。在中位随访 18 个月期间，低评分组和高评分组的 MACCE 发生率分别为 8.8%和 37.5%（p<0.001）；两组的心脏死亡率分别为 2.5%和 12.5%（p<0.05）。此外，高评分组的累积无心脏死亡（97.5%比 86.8%，p<0.05）和 MACCE（75.2%比 52.8%，p<0.001）生存率明显低于低评分组。Cox 比例风险回归分析表明，ACEF II 评分是 MACCE 的独立预后指标，风险比（HR）为 2.24，p=0.003。ROC 曲线分析表明，ACEF II 评分预测 MACCE 的曲线下面积（AUC）为 0.740（p<0.001），而 SYNTAX 评分 II CABG 的 AUC 为 0.621（p=0.070），EuroSCORE II 的 AUC 为 0.703（p<0.001）。因此，ACEF II 评分的准确预测价值与 EuroSCORE II 相似，但明显高于 SYNTAX 评分 II CABG。
结论
与其他风险模型相比，更新后的 ACEF II 评分是一种更方便且经过验证的预测 MVCAD 患者一站式 HCR 后 MACCE 的工具。
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