Aizawa Takatoku, Nagao Tomoaki, Oda Yusuke, Nakano Suguru, Ito Kazuki, Shirai Yusuke, Hosoya Natsuko, Sawasaki Kohei, Arai Junji, Fujita Shinya, Muto Masahiro, Oda Teiji, Maekawa Yuichiro
Department of Cardiology, Hamamatsu Medical Center, Hamamatsu, Japan.
Division of Cardiology, Department of Internal Medicine Ⅲ, Hamamatsu University of Medicine, Hamamatsu, Japan.
Front Cardiovasc Med. 2024 May 28;11:1388686. doi: 10.3389/fcvm.2024.1388686. eCollection 2024.
The mortality rate of acute coronary syndrome (ACS) remains high. Therefore, patients with ACS should undergo early risk stratification, for which various risk calculation tools are available. However, it remains uncertain whether the predictive performance varies over time between risk calculation tools for different target periods. This study aimed to compare the predictive performance of risk calculation tools in estimating short- and long-term mortality risks in patients with ACS, while considering different observation periods using time-dependent receiver operating characteristic (ROC) analysis.
This study included 404 consecutive patients with ACS who underwent coronary angiography at our hospital from March 2017 to January 2021. The ACTION and GRACE scores for short-term risk stratification purposes and CRUSADE scores for long-term risk stratification purposes were calculated for all participants. The participants were followed up for 36 months to assess mortality. Using time-dependent ROC analysis, we evaluated the area under the curve (AUC) of the ACTION, CRUSADE, and GRACE scores at 1, 6, 12, 24, and 36 months.
Sixty-six patients died during the observation periods. The AUCs at 1, 6, 12, 24, and 36 months of the ACTION score were 0.942, 0.925, 0.889, 0.856, and 0.832; those of the CRUSADE score were 0.881, 0.883, 0.862, 0.876, and 0.862; and those of the GRACE score 0.949, 0.928, 0.888, 0.875, and 0.860, respectively.
The ACTION and GRACE scores were excellent risk stratification tools for mortality in the short term. The prognostic performance of each risk score was almost similar in the long term, but the CRUSADE score might be a superior risk stratification tool in the longer term than 3 years.
急性冠状动脉综合征（ACS）的死亡率仍然很高。因此，ACS患者应进行早期风险分层，有多种风险计算工具可供使用。然而，不同目标时期的风险计算工具之间的预测性能是否随时间变化仍不确定。本研究旨在使用时间依赖性受试者工作特征（ROC）分析，比较风险计算工具在估计ACS患者短期和长期死亡风险方面的预测性能，同时考虑不同的观察期。
本研究纳入了2017年3月至2021年1月在我院接受冠状动脉造影的404例连续ACS患者。为所有参与者计算用于短期风险分层的ACTION和GRACE评分以及用于长期风险分层的CRUSADE评分。对参与者进行36个月的随访以评估死亡率。使用时间依赖性ROC分析，我们评估了ACTION、CRUSADE和GRACE评分在1、6、12、24和36个月时的曲线下面积（AUC）。
66例患者在观察期内死亡。ACTION评分在1、6、12、24和36个月时的AUC分别为0.942、0.925、0.889、0.856和0.832；CRUSADE评分的AUC分别为0.881、0.883、0.862、0.876和0.862；GRACE评分的AUC分别为0.949、0.928、0.888、0.875和0.860。
ACTION和GRACE评分是短期死亡率的优秀风险分层工具。各风险评分的长期预后性能几乎相似，但CRUSADE评分在超过3年的长期可能是更好的风险分层工具。
