【摘要】 目的回顾性分析比较GRACE与TIMI危险评分对急性冠脉综合征(ACS)患者住院期间发生心脏性死亡的预测价值。方法查阅2008-01~2012-12期间在我院住院发生心脏性死亡且接受过冠状动脉造影的ACS患者45例为死亡组。随机抽取同期未发生心脏性死亡的ACS患者166例为存活组。收集临床变量资料分别进行GRACE与TIMI评分。分别描绘两种评分的ROC曲线并计算曲线下面积(AUC),以及采用非参数检验对AUC进行比较。结果GRACE评分在141分预测发生心脏性死亡事件的敏感度和特异度均较好,分别为79.4%和84.9%(AUC0.893,95%CI0.830~0.956);TIMI评分在3.5分预测发生心脏性死亡事件的敏感度和特异度分别为73.5%和64.0%(AUC 0.768,95%CI 0.680~0.856)。两种危险评分曲线下面积比较差异有统计学意义(P<0.05),GRACE评分曲线下面积大于TIMI评分,GRACE较TIMI评分的预测价值更高。结论GRACE和TIMI危险评分对ACS患者住院期间发生心脏性死亡均有较好的预测价值,其中GRACE较TIMI危险评分的预测价值更高。更多还原

【Abstract】 Objective To Compare GRACE and TIMI risk scores in the evaluation of prognosis of in- hospital cardiac death in patients with acute coronary syndromes(ACS).Methods The patients with ACS who were admitted to hospitals consecutively from Jan.2008 to Dec.2012 were enrolled in this study.There were 45 ACS patients with in- hospital cardiac deaths and known coronary artery disease(CAD)(prior stenosis ≥50%) or stenosis ≥50%of in- hospital coronary arteriography.Survival group consisted of 166 random contemporary ACS patients with known CAD(prior stenosis ≥50%) or stenosis ≥50%of in- hospital coronary arteriography.The TIMI and GRACE risk scores were calculated according to the baseline characteristics on admission.The predictive value of the model was assessed with evaluation of the area under curve(AUC) in receiver- operating characteristic analysis.C- statistics were calculated to compare the discriminative capacities of different risk scores for in-hospital cardiac death.The areas under correlated ROC curves were compared by a nonparametric approach.Results When GRACE RS was 141,sensitivity(79.4%) and specificity(84.9%) of prediction for cardiac death were both fine.When TIMI RS was 3.5,sensitivity(73.5%) and specificity(64.0%) of prediction for cardiac death were both fine.For in- hospital cardiac death,the AUC(0.893) of GRACE RS was more than the AUC(0.768) of TIMI RS,so GRACE risk score displayed better discrimination than the TIMI score significantly(P < 0.001).Conclusion GRACE RS and TIMI RS both display high predictive value,but GRACE RS is proved to be superior.更多还原