Zykov M V, Dyachenko N V, Velieva R M, Kashtalap V V, Barbarash O L
Research Institute for Complex Issues of Cardiovascular Diseases.
Kuban State Medical University.
Ter Arkh. 2022 Aug 12;94(7):816-821. doi: 10.26442/00403660.2022.07.201742.
To assess the possibilities of using comorbidity indices together with the GRACE (Global Registry of Acute Coronary Events) scale to assess the risk of hospital mortality in acute coronary syndrome (ACS).
The registry study included 2,305 patients with ACS. The frequency of coronary angiography was 54.0%, percutaneous coronary intervention (PCI) 26.9%. Hospital mortality with ACS was 4.8%, with myocardial infarction 9.4%. All patients underwent a comorbidity assessment according to the CIRS system (Cumulative Illness Rating Scale), according to the CCI (Charlson Comorbidity Index) and the CDS (Chronic Disease Score) scale, according to their own scale, which is based on the summation of 9 diseases (diabetes mellitus, atrial fibrillation, stroke, arterial hypertension, obesity, peripheral atherosclerosis, thrombocytopenia, anemia, chronic kidney disease). All patients underwent a mortality risk assessment using the GRACE ACS Risk scale.
It was found that the CDS and CIRS indices are not associated with the risk of hospital mortality. With CCI3, the frequency of death outcomes increased from 4.1 to 6.1% (2=4.12, p=0.042). With an increase in the severity of comorbidity from minimal (no more than 1 disease) to severe (4 or more diseases) according to its own scale, hospital mortality increased from 1.2 to 7.4% (2=23.8, p0.0001). In contrast to other scales of comorbidity, our own model more efficiently estimates the hospital prognosis both in the conservative treatment group (2=8.0, p=0.018) and in the PCI group (2=28.5, p=0.00001). It was in the PCI subgroup that the comorbidity factors included in their own model made it possible to increase the area under the ROC curve of the GRACE scale from 0.80 (0.740.87) to 0.90 (0.850.95).
CCI and its own comorbidity model, but not CDS and CIRS, are associated with the risk of hospital mortality. The model for assessing comorbidity on a 9-point scale, but not CCI, CDS and CIRS, can significantly improve the predictive value of the GRACE scale.
评估合并症指数与全球急性冠状动脉事件注册登记（GRACE）量表联合使用以评估急性冠状动脉综合征（ACS）患者院内死亡风险的可能性。
该注册登记研究纳入了2305例ACS患者。冠状动脉造影的频率为54.0%，经皮冠状动脉介入治疗（PCI）为26.9%。ACS患者的院内死亡率为4.8%，心肌梗死患者为9.4%。所有患者均根据累积疾病评分量表（CIRS系统）、查尔森合并症指数（CCI）、慢性病评分（CDS）量表以及基于9种疾病（糖尿病、心房颤动、中风、动脉高血压、肥胖、外周动脉粥样硬化、血小板减少症、贫血、慢性肾脏病）总和的自行设计量表进行合并症评估。所有患者均使用GRACE ACS风险量表进行死亡风险评估。
发现CDS和CIRS指数与院内死亡风险无关。CCI为3时，死亡结局的频率从4.1%增至6.1%（χ² = 4.12，p = 0.042）。根据自行设计的量表，合并症严重程度从轻度（不超过1种疾病）增加到重度（4种或更多疾病）时，院内死亡率从1.2%增至7.4%（χ² = 23.8，p < 0.0001）。与其他合并症量表不同，我们自行设计的模型在保守治疗组（χ² = 8.0，p = 0.018）和PCI组（χ² = 28.5，p = 0.00001）中均能更有效地评估院内预后。正是在PCI亚组中，自行设计模型纳入的合并症因素使得GRACE量表的ROC曲线下面积从0.80（0.74 - 0.87）增至0.90（0.85 - 0.95）。
CCI及其自行设计的合并症模型与院内死亡风险相关，而CDS和CIRS则不然。基于9分制的合并症评估模型而非CCI、CDS和CIRS能够显著提高GRACE量表的预测价值。
