【摘要】 目的探讨HEARTS3评分系统对急性胸痛患者30 d重大心血管不良事件(MACE)的预测价值。方法选取2016年1月至2019年5月于洪湖市人民医院心血管内科收治的620例急性胸痛患者为研究对象,所有患者均使用HEART和HEARTS3评分系统对患者病情的危险程度评分,并对两组发病后30 d内的MACE发生情况随访。分析评分结果与MACE发生的关系,并比较两种评分系统对MACE的预测价值。结果发病后30 d内共75例(12.10%)患者发生MACE,非MACE患者545例(87.90%)。MACE组的平均年龄明显大于非MACE组,男性占比及糖尿病、高血压、吸烟、血脂异常、心肌梗死病史、冠心病家族史、经皮冠状动脉介入治疗(PCI)史发生率均显著高于非MACE组(P<0.05)。HEART与HEARTS3评分低危者均未发生MACE。HEARTS3评分高危者中的MACE发生率显著高于HEART评分高危者,中危者的MACE发生率显著低于HEART评分中危者(P<0.05)。ROC曲线显示HEART评分为6分时,AUC值最大(0.909),预测的敏感性、特异性分别为71.85%、97.60%;HEARTS3评分为10分时,AUC值最大(0.974),预测的敏感性、特异性分别为85.82%、97.82%。HEART与HEARTS3评分系统预测MACE的特异性接近(P>0.05),与HEART评分系统相比,HEARTS3评分系统对MACE的预测敏感性更高(P<0.05)。结论 HEART和HEARTS3评分系统均可用于急性胸痛患者的危险分层,但HEART3评分系统对患者MACE发生风险的预测敏感性更高。更多还原

【Abstract】 Objective To discuss the predictive value of HEARTS3 scoring system to major adverse cardiovascular events(MACE) in patients with acute chest pain in 30 d. Methods The patients with acute chest pain(n=620) were chosen from Department of Cardiovascular Medicine in People’s Hospital of Honghu City from Jan. 2016 to May 2019. All patients were given scored on risk degree by applying HEART and HEARTS3 scoring systems respectively. The incidence of MACE was followed up in 2 groups within 30 d after MACE attack. The relationship between scoring results and MACE incidence was analyzed, and predictive value to MACE was compared between 2 systems. Results There were 75(12.10%) patients with MACE(MACE group), and 545(87.90%) patients without MACE(non-MACE group). The average age was significantly elder in MACE group than that in non-MACE group, and male case proportion and incidence rates of diabetes, hypertension, smoking, dyslipidemia, history of myocardial infarction, family history of coronary heart disease and history of PCI were all significantly higher in MACE group than those in non-MACE group(P<0.05). There was no incidence of MACE in patients with low-risk HEART and HEARTS3 scores. The incidence rate of MACE was significantly higher in patients with high-risk HEARTS3 score than that in patients with high-risk HEART score, and was significantly lower in patients with middle-risk HEARTS3 score than that in patients with middle-risk HEART score(P<0.05). The results of ROC analysis showed that when HEART score was 6, AUC value was the highest(0.909), and sensitivity was 71.85% and specificity was 97.60%. When HEARTS3 score was 10, AUC value was the highest(0.974), and sensitivity was 85.82% and specificity was 97.82%. The specificity for predicting MACE was similar between HEART and HEARTS3 scoring systems(P>0.05). The predictive sensitivity of HEARTS3 scoring system for MACE was higher compared with that of HEART scoring system(P<0.05). Conclusion HEART and HEARTS3 scoring systems can be used in risk stratification in patients with acute chest pain, while HEART3 scoring system has higher sensitivity in predicting MACE risk.更多还原