■急性ST段抬高型心肌梗死(STEMI)具有较高的发病率和死亡率。充血性心力衰竭,高血压,年龄,糖尿病,既往卒中/短暂性脑缺血发作(2分)(CHADS2)和年龄>75岁血管疾病(CHA2DS2-VASc)评分为2分的CHADS2评分被广泛用于非瓣膜性心房颤动卒中的风险分层管理,在心血管疾病中具有较高的预后价值.本研究旨在探讨急诊CHADS2和CHA2DS2-VASc评分对急性STEMI患者冠状动脉病变及预后的预测价值。
■选择2018年5月至2021年10月的524例STEMI患者进行急诊CHADS2和CHA2DS2-VASc。收集临床数据和实验室指标。评估患者的冠状动脉疾病(CAD)和预后。采用Logistic回归和受试者工作特征(ROC)曲线对数据进行分析。
■在严重组,CysC水平,CHADS2、CHA2DS2-VASc评分与糖尿病患者比例、中风或短暂性脑缺血发作(TIA),充血性心力衰竭,吸烟史,Killip≥2级高于轻度和中度组。在预后不良组中,血清肌酐(Crea)水平,CysC,血红蛋白(Hb),CHADS2、CHA2DS2-VASc评分与高血压比例、糖尿病,中风或TIA,充血性心力衰竭,吸烟史,Killip≥2级高于预后良好组。糖尿病(或,3.678;95%CI:2.876-5.872,0.008),CHADS2(或,3.829;95%CI:2.310-5.832,0.003)和CHA2DS2-VASc评分(OR,4.671;95%CI:3.125~6.187,0.000)是CAD严重程度的独立危险因素(P<0.05)。糖尿病(或,3.287;95%CI:2.231-5.123,0.012),基利普等级≥2(或,2.212;95%CI:1.023-2.987,0.045),LVEF(或,3.110;95%CI:2.124-5.031,0.023),CHADS2(或,3.228;95%CI:2.133-5.886,0.005)和CHA2DS2-VASc评分(OR,3.988;95%CI:2.987~5.873,0.001)是影响急性STEMI患者预后的独立危险因素。CHA2DS2-VASc评分评价CAD及预后的曲线下面积(AUC)值分别为0.947、0.931,高于CHADS2评分(0.836、0.812)(P<0.05)。
■多因素共同影响急性STEMI患者CAD的严重程度和预后。CHA2DS2-VASc评分在预测患者冠状动脉病变严重程度及预后方面优于CHADS2评分,为临床实践提供理论支持。
UNASSIGNED: Acute ST-segment elevation myocardial infarction (STEMI) has a high morbidity and mortality rate. The congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack (2 points) (CHADS2) and CHADS2 score with 2 points assigned for age >75 years-vascular disease (CHA2DS2-VASc) scores are widely used for risk stratification management of non-valvular atrial fibrillation stroke and have high prognostic value in cardiovascular disease. This
study aims to investigate the predictive value of the emergency CHADS2 and CHA2DS2-VASc score on coronary artery lesions and prognosis in patients with acute STEMI.
UNASSIGNED: A total of 524 patients with STEMI from May 2018 to October 2021 were selected for emergency CHADS2 and CHA2DS2-VASc. Clinical data and laboratory indicators were collected. Patients were evaluated for coronary artery disease (CAD) and prognosis. Logistic regression and the receiver operating characteristic (ROC) curve were used to analyze the data.
UNASSIGNED: In severe group, CysC levels, CHADS2, CHA2DS2-VASc score and the proportion of diabetes, stroke or transient ischemic attack (TIA), congestive heart failure, smoking history, Killip class ≥2 was higher than that in mild and moderate group. In poor prognosis group, levels of serum creatinine (Crea), CysC, hemoglobin (Hb), CHADS2, CHA2DS2-VASc score and the proportion of hypertension, diabetes, stroke or TIA, congestive heart failure, smoking history, and Killip class ≥2 was higher than that in good prognosis group. Diabetes (OR, 3.678; 95% CI: 2.876-5.872, 0.008), CHADS2 (OR, 3.829; 95% CI: 2.310-5.832, 0.003) and CHA2DS2-VASc score (OR, 4.671; 95% CI: 3.125-6.187, 0.000) were independent risk factors for the severity of CAD (P<0.05). Diabetes (OR, 3.287; 95% CI: 2.231-5.123, 0.012), Killip class ≥2 (OR, 2.212; 95% CI: 1.023-2.987, 0.045), LVEF (OR, 3.110; 95% CI: 2.124-5.031, 0.023), CHADS2 (OR, 3.228; 95% CI: 2.133-5.886, 0.005) and CHA2DS2-VASc score (OR, 3.988; 95% CI: 2.987-5.873, 0.001) were independent risk factors for prognosis of acute STEMI patients. Area under curve (AUC) value of CHA2DS2-VASc score in evaluating CAD and prognosis was 0.947, 0.931, higher than that of the CHADS2 score (0.836, 0.812) (P<0.05).
UNASSIGNED: Multiple factors jointly affect the severity and prognosis of CAD in patients with acute STEMI. The CHA2DS2-VASc score is better than the CHADS2 score in predicting the severity of coronary artery lesions and prognosis of patients, providing theoretical support for clinical practice.