中国全科医学 ›› 2023, Vol. 26 ›› Issue (33): 4130-4136.DOI: 10.12114/j.issn.1007-9572.2023.0109

• 论著 • 上一篇    下一篇

CHA2DS2-VASc卒中风险评分对冠心病三支血管或左主干病变患者主要不良心血管事件的预测价值研究

王秋实, 李虹伟*()   

  1. 100050 北京市,首都医科大学附属北京友谊医院心内科
  • 收稿日期:2023-03-24 修回日期:2023-04-24 出版日期:2023-11-20 发布日期:2023-05-12
  • 通讯作者: 李虹伟

  • 作者贡献:王秋实提出主要研究目标,负责研究的构思与设计,进行数据的收集与整理,统计学处理,图、表的绘制与展示,撰写论文;李虹伟负责文章的质量控制与审查,监督管理,对文章整体负责。
  • 基金资助:
    北京市临床重点专科项目(京卫医〔2018〕204号)

The Predictive Value of CHA2DS2-VASc Score on Major Adverse Cardiovascular Events in Patients with Three Vessels or Left Main Diseases of Coronary Heart Disease

WANG Qiushi, LI Hongwei*()   

  1. Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
  • Received:2023-03-24 Revised:2023-04-24 Published:2023-11-20 Online:2023-05-12
  • Contact: LI Hongwei

摘要: 背景 SYNTAX评分是基于冠状动脉解剖结构和病变情况,预测冠心病患者预后常用的评分系统之一,但临床上需要一种基于一般临床资料的评估方法,以提高其预测效力。 目的 探讨CHA2DS2-VASc卒中风险评分在冠心病三支血管病变(TVD)或左主干病变(LMD)患者中与主要不良心血管事件(MACEs)之间的关系。 方法 本研究共纳入2009年1月—2014年5月在首都医科大学附属北京友谊医院接受经皮冠状动脉介入治疗(PCI)的630例TVD/LMD患者,根据SYNTAX评分分为轻度病变组(0~22分)276例、中度病变组(23~32分)249例和重度病变组(≥33分)105例。采用Pearson相关性分析及偏相关分析探究定量资料之间的相关性,采用单因素及多因素Logistic回归分析探究CHA2DS2-VASc和SYNTAX评分是否为TVD/LMD患者3年内发生MACEs的危险因素。绘制受试者工作特征(ROC)曲线评价CHA2DS2-VASc评分预测3年内发生MACE的效能。使用Delong方法对CHA2DS2-VASc评分、SYNTAX评分以及两评分系统联合预测MACEs的ROC曲线进行比较。 结果 不同SYNTAX评分组在年龄、合并充血性心力衰竭、估算肾小球滤过率(eGFR)、左心室射血分数(LVEF)、SYNTAX评分、CHA2DS2-VASc评分、3年内MACEs、死亡和非致死性心肌梗死比较,差异有统计学意义(P<0.05),CHA2DS2-VASc评分与SYNTAX评分呈正相关(r=0.109,P=0.003)。多因素Logistic回归分析结果显示,高血压〔OR=1.753,95%CI(1.047,2.938)〕、LVEF〔OR=0.962,95%CI(0.942,0.982)〕、SYNTAX评分〔OR=1.028,95%CI(1.002,1.055)〕及CHA2DS2-VASc评分〔OR=1.210,95%CI(1.070,1.369)〕升高是TVD/LMD患者3年内发生MACEs的独立影响因素(P<0.05)。ROC曲线分析结果显示,SYNTAX评分预测MACEs的ROC曲线下面积(AUC)是0.638,CHA2DS2-VASc评分预测MACEs的AUC是0.619。联合应用SYNTAX评分及CHA2DS2-VASc评分预测MACEs的AUC是0.685。使用Delong方法进行头对头比较发现,SYNTAX与CHA2DS2-VASc评分预测MACEs的AUC差值为0.019(P=0.587),提示SYNTAX与CHA2DS2-VASc评分都具有对MACEs的预测效果,但其AUC差值无统计学意义。联合应用SYNTAX评分和CHA2DS2-VASc评分预测MACEs与SYNTAX评分单独预测MACEs的AUC差值为0.046 9(P=0.046),与CHA2DS2-VASc评分单独预测MACE的AUC差值为0.065 9(P=0.043),差异均有统计学意义。 结论 CHA2DS2-VASc评分系统可用于预测TVD/LMD患者冠状动脉病变的严重程度及3年内MACE的发生情况,联合CHA2DS2-VASc与SYNTAX评分系统,可有效提高对3年MACEs的预测价值。

关键词: 冠心病, CHA2DS2-VASc评分, SYNTAX评分, 三支血管病变, 左主干病变, 预测价值

Abstract:

Background

SYNTAX score is the most common system for predicting the prognosis of patients with coronary heart disease based on coronary anatomy and lesions, and an evaluation method based on general clinical data is needed to improve the effectiveness of prediction.

Objective

To investigate the relationship between CHA2DS2-VASc scores and major adverse cardiovascular events in patients with three-vessel disease (TVD) or left main coronary artery disease (LMD) .

Methods

A total of 630 TVD/LMD patients were enrolled, and 276 patients were divided into the mild lesion group (0—22 points), 249 cases in the moderate lesion group (23—32 points) and 105 cases in the severe lesion group (≥33 points) according to SYNTAX score. Pearson correlation analysis and partial correlation analysis were used to explore the correlation between quantitative data, and univariate and multivariate Logistic regression analysis were used to investigate whether CHA2DS2-VASc and SYNTAX scores were risk factors for the incidence of MACEs within 3 years. The receiver operating characteristic (ROC) curve was plotted to evaluate the CHA2DS2-VASc score in predicting the occurrence of MACEs within 3 years. The ROC curves for predicting MACEs of CHA2DS2-VASc score, SYNTAX score, and the combination of the two scoring systems were compared using the Delong method.

Results

There were statistically significant differences in age, congestive heart failure, eGFR, LVEF, SYNTAX score, CHA2DS2-VASc score, MACEs within 3 years, death and non-fatal myocardial infarction among the groups with diferent degree of coronary stenosis (P<0.05), and CHA2DS2-VASc score was positively correlated with SYNTAX score (r=0.109, P=0.003). Multivariate Logistic regression analysis showed that hypertension〔OR=1.753, 95%CI (1.047, 2.938) 〕, LVEF 〔OR=0.962, 95%CI (0.942, 0.982) 〕, SYNTAX score 〔OR=1.028, 95%CI (1.002, 1.055) 〕, and CHA2DS2-VASc score 〔OR=1.210, 95%CI (1.070, 1.369) 〕 were independent influencing factors of MACEs of TVD/LMD patients within 3 years (P<0.05). ROC curve analysis showed that AUC of SYNTAX score predicting MACEs is 0.638, and AUC of CHA2DS2-VASc score predicting MACEs is 0.619. The AUC of combined SYNTAX and CHA2DS2-VASc score predicting MACEs was 0.685. The AUC difference between SYNTAX and CHA2DS2-VASc score was 0.019 (P=0.587) by Delong method, indicating that both SYNTAX and CHA2DS2-VASc scores had a predictive effect on MACEs, but the AUC difference was not statistically significant. The AUC difference between the combined two kind of score and SYNTAX score alone was 0.046 9 (P=0.046), and the AUC difference between the combined two kind of scores and CHA2DS2-VASc score oalone was 0.065 9 (P=0.043) .

Conclusion

The CHA2DS2-VASc score can be used to predict coronary artery severity and MACEs within 3 years in patients with three-vessel disease/left main coronary artery disease. Combined CHA2DS2-VASc and SYNTAX scoring system can effectively improved the predictive value of MACEs within 3 years.

Key words: Coronary artery disease, CHA2DS2-VASc score, SYNTAX score, Triple-vessel diseases, Left main disease, Predictive value