■建立改良的全球急性冠状动脉事件注册(GRACE)评分系统,与传统的GRACE评分系统相比,具有改进的预测性能。
■从2015年1月1日至2020年12月31日在新疆医科大学第一附属医院心脏中心通过医院电子病历系统确诊为急性心肌梗死(AMI)住院的5512例患者。在应用纳入和排除标准后,共纳入4561例患者。平均随访51.8±23.4个月。根据终点事件将患者分为死亡组和活着组。比较两组间的差异采用双样本t检验和卡方检验。调整了传统危险因素以及LogBNP(B型利钠肽前体,BNP)和改良的GRACE评分系统包括在多因素COX回归模型中。通过(接收器工作特性)ROC曲线比较传统和改进的GRACE评分系统的预测性能。
■年龄差异显著,心率,肌酐,尿酸,LogBNP,传统的GRACE评分,通过双样本t检验,在死亡组和活着组之间发现了改良的GRACE评分。通过卡方检验对两组进行比较,发现死亡组男性发病率较高;心功能分级较高;既往有高血压病史,糖尿病,冠状动脉疾病(CAD),或脑血管疾病;吸烟史;需要主动脉内球囊反搏(IABP)支持;更多的患者服用阿司匹林,氯吡格雷,替格瑞洛,和β受体阻滞剂。结果通过多因素COX回归模型进行分析,在调整了混杂因素后,年龄,心功能类别,CAD的历史,使用阿司匹林和β受体阻滞剂,发现改良GRACE评分系统与AMI患者全因死亡率(ACM)相关.ROC曲线用于比较常规GRACE评分系统与改良GRACE评分系统的预测性能,并发现改良GRACE评分系统(曲线下面积(AUC)=0.809,p<0.001,95%(置信区间)CI(0.789-0.829))明显优于传统GRACE评分系统(AUC=0.786,p<0.001,95%CI(0.764-0.808)),两种评分的比较有统计学意义(p<0.001).修改后的GRACE评分进行10倍交叉内部验证后,C统计量的变化不显著,并且以IDI=0.019>0计算新旧模型之间的综合判别改进(IDI),表明修改后的GRACE得分比传统GRACE得分有积极的改善。
■修改后的GRACE评分系统,结合B型利钠肽前体(BNP)和传统的GRACE评分系统,在AMI患者中与ACM独立相关,具有比传统GRACE评分系统更大的AUC和更高的预测价值。
■NCT02737956。
UNASSIGNED: To establish a modified Global Registry of Acute Coronary Events (GRACE) scoring system with an improved predictive performance compared with the traditional GRACE scoring system.
UNASSIGNED: We identified 5512 patients who were hospitalized with a definite diagnosis of acute myocardial infarction (AMI) from January 1, 2015, to December 31, 2020, at the Heart Center of the First Affiliated Hospital of Xinjiang Medical University through the hospital\'s electronic medical record system. A total of 4561 patients were enrolled after the inclusion and exclusion criteria were applied. The mean follow-up was 51.8 ± 23.4 months. The patients were divided into dead and alive groups by endpoint events. The differences between the two groups were compared using the two-sample t test and chi-square test. Adjusted traditional risk factors as well as LogBNP (B-type natriuretic peptide precursor, BNP) and the modified GRACE scoring system were included in a multifactorial COX regression model. The predictive performance of the traditional and modified GRACE scoring systems was compared by (Receiver Operating Characteristic) ROC curves.
UNASSIGNED: Significant differences in age, heart rate, creatinine, uric acid, LogBNP, traditional GRACE score, and modified GRACE score were found between the dead and alive groups by the two-sample t test. Comparison of the two groups by the chi-square test revealed that the dead group had a higher incidence of males; higher cardiac function class; a previous history of hypertension, diabetes, coronary artery disease (CAD), or cerebrovascular disease; a history of smoking; the need for intra-aortic balloon pump (IABP) support; and more patients taking aspirin, clopidogrel, ticagrelor, and β -blockers. The results were analyzed by a multifactorial COX regression model, and after adjusting for confounders, age, cardiac function class, history of CAD, use of aspirin and β -blockers, and the modified GRACE scoring system were found to be associated with all-cause mortality (ACM) in patients with AMI. The ROC curve was used to compare the predictive performance of the conventional GRACE scoring system with that of the modified GRACE scoring system, and it was found that the modified GRACE scoring system (Area Under Curve (AUC) = 0.809, p < 0.001, 95% (Confidence Interval) CI (0.789-0.829)) was significantly better than the traditional GRACE scoring system (AUC = 0.786, p < 0.001, 95% CI (0.764-0.808)), the comparison between the two scores was statistically significant (p < 0.001). The change in the C statistic after 10-fold crossover internal validation of the modified GRACE score was not significant, and the integrated discrimination improvement (IDI) between the old and new models was calculated with IDI = 0.019 > 0, suggesting that the modified GRACE score has a positive improvement on the traditional GRACE score.
UNASSIGNED: The modified GRACE scoring system, established by combining B-type natriuretic peptide precursor (BNP) and the traditional GRACE scoring system, was independently associated with ACM in patients with AMI, with a larger AUC and higher predictive value than the traditional GRACE scoring system.
UNASSIGNED: NCT02737956.