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

doi:10.12114/j.issn.1007-9572.2023.0109

Abstract

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

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

WANG Qiushi,LI Hongwei. 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[J]. Chinese General Practice, 2023, 26(33): 4130-4136. DOI: 10.12114/j.issn.1007-9572.2023.0109.
王秋实,李虹伟. 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[J]. 中国全科医学, 2023, 26(33): 4130-4136. DOI: 10.12114/j.issn.1007-9572.2023.0109.

Figures/Tables 6

References 21

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组别	例数	性别（男/女）	年龄（岁）	BMI 〔M（P₂₅，P₇₅），kg/m²〕	高血压〔例（%）〕	糖尿病〔例（%）〕	吸烟史〔例（%）〕	充血性心力衰竭〔例（%）〕
轻度病变组	276	212/64	61.99±10.97	24.2（22.2，26.2）	183（66.3）	85（30.8）	113（40.9）	55（20.0）
中度病变组	249	192/57	66.06±10.53	24.2（22.0，26.4）	175（70.3）	82（32.9）	102（41.0）	100（40.2）
重度病变组	105	84/21	65.94±11.39	24.4（22.8，26.4）	65（61.9）	37（35.2）	50（47.6）	61（58.1）
检验统计量值		0.472^a	10.710^b	0.899^c	2.505^a	0.742^a	1.201^a	55.253^a
P值		0.790	<0.001	0.638	0.286	0.690	0.549	<0.001
组别	外周血管疾病〔例（%）〕	心房颤动〔例（%）〕	TC 〔M（P₂₅，P₇₅），mmol/L〕	HDL-C 〔M（P₂₅，P₇₅），mmol/L〕	LDL-C 〔M（P₂₅，P₇₅），mmol/L〕	肌酐（μmol/L）	eGFR 〔mL·min^-1·（1.73m²）^-1〕
轻度病变组	215（77.9）	6（2.2）	4.61（4.14，5.67）	1.18（1.02，1.37）	2.92（2.41，3.74）	107.45±78.28	89.66±30.31
中度病变组	215（86.3）	9（3.6）	4.86（4.20，5.93）	1.20（1.03，1.37）	3.13（2.54，3.91）	113.61±79.18	83.23±29.44
重度病变组	87（82.9）	1（1.0）	5.01（4.00，5.88）	1.12（0.94，1.36）	3.11（2.42，3.85）	118.05±82.40	80.25±28.47
检验统计量值	0.278^a	2.390^a	2.874^c	2.489^c	2.442^c	0.805^b	5.084^b
P值	0.870	0.303	0.238	0.288	0.295	0.448	0.006
组别	血红蛋白（g/L）	LVEF （%）	MACEs 〔例（%）〕	死亡〔例（%）〕	非致死心肌梗死〔例（%）〕	SYNTAX评分（分）	CHA₂DS₂-VASc评分（分）
轻度病变组	130.65±16.48	50.03±7.96	26（9.4）	22（8.0）	4（1.4）	16.69±3.56	3.18±1.87
中度病变组	129.72±16.95	45.66±10.52	47（18.9）	37（14.9）	10（4.0）	26.72±2.64	4.33±1.98
重度病变组	127.43±17.21	42.67±12.09	23（21.9）	14（13.3）	9（8.6）	38.45±5.80	4.42±2.11
检验统计量值	1.392^b	25.552^b	20.781^a	6.438^a	11.125^a	1 386.604^b	28.512^b
P值	0.249	<0.001	<0.001	0.040	0.004	<0.001	<0.001

组别	例数	性别（男/女）	年龄（岁）	BMI 〔M（P₂₅，P₇₅），kg/m²〕	高血压〔例（%）〕	糖尿病〔例（%）〕	吸烟史〔例（%）〕	充血性心力衰竭〔例（%）〕
轻度病变组	276	212/64	61.99±10.97	24.2（22.2，26.2）	183（66.3）	85（30.8）	113（40.9）	55（20.0）
中度病变组	249	192/57	66.06±10.53	24.2（22.0，26.4）	175（70.3）	82（32.9）	102（41.0）	100（40.2）
重度病变组	105	84/21	65.94±11.39	24.4（22.8，26.4）	65（61.9）	37（35.2）	50（47.6）	61（58.1）
检验统计量值		0.472^a	10.710^b	0.899^c	2.505^a	0.742^a	1.201^a	55.253^a
P值		0.790	<0.001	0.638	0.286	0.690	0.549	<0.001
组别	外周血管疾病〔例（%）〕	心房颤动〔例（%）〕	TC 〔M（P₂₅，P₇₅），mmol/L〕	HDL-C 〔M（P₂₅，P₇₅），mmol/L〕	LDL-C 〔M（P₂₅，P₇₅），mmol/L〕	肌酐（μmol/L）	eGFR 〔mL·min^-1·（1.73m²）^-1〕
轻度病变组	215（77.9）	6（2.2）	4.61（4.14，5.67）	1.18（1.02，1.37）	2.92（2.41，3.74）	107.45±78.28	89.66±30.31
中度病变组	215（86.3）	9（3.6）	4.86（4.20，5.93）	1.20（1.03，1.37）	3.13（2.54，3.91）	113.61±79.18	83.23±29.44
重度病变组	87（82.9）	1（1.0）	5.01（4.00，5.88）	1.12（0.94，1.36）	3.11（2.42，3.85）	118.05±82.40	80.25±28.47
检验统计量值	0.278^a	2.390^a	2.874^c	2.489^c	2.442^c	0.805^b	5.084^b
P值	0.870	0.303	0.238	0.288	0.295	0.448	0.006
组别	血红蛋白（g/L）	LVEF （%）	MACEs 〔例（%）〕	死亡〔例（%）〕	非致死心肌梗死〔例（%）〕	SYNTAX评分（分）	CHA₂DS₂-VASc评分（分）
轻度病变组	130.65±16.48	50.03±7.96	26（9.4）	22（8.0）	4（1.4）	16.69±3.56	3.18±1.87
中度病变组	129.72±16.95	45.66±10.52	47（18.9）	37（14.9）	10（4.0）	26.72±2.64	4.33±1.98
重度病变组	127.43±17.21	42.67±12.09	23（21.9）	14（13.3）	9（8.6）	38.45±5.80	4.42±2.11
检验统计量值	1.392^b	25.552^b	20.781^a	6.438^a	11.125^a	1 386.604^b	28.512^b
P值	0.249	<0.001	<0.001	0.040	0.004	<0.001	<0.001

变量	β	SE	Wald χ²值	P值	OR（95%CI）
性别
男	0.415	0.238	3.026	0.082	1.514（0.949，2.416）
年龄	0.040	0.010	14.654	<0.001	1.040（1.019，1.062）
BMI	0.056	0.032	2.990	0.084	0.945（0.887，1.008）
高血压
有高血压	0.290	0.220	1.735	0.188	1.336（0.868，2.056）
糖尿病
有糖尿病	-0.219	0.219	2.761	0.097	0.694（0.452，1.068）
吸烟史
有吸烟史	0.113	0.218	0.268	0.605	1.119（0.730，1.715）
eGFR	-0.012	0.004	10.127	0.001	0.988（0.981，0.995）
LVEF	-0.037	0.008	19.200	<0.001	0.964（0.948，0.980）
CHA₂DS₂-VASc评分	0.210	0.052	16.061	<0.001	1.233（1.113，1.367）
SYNTAX评分	0.051	0.012	18.689	<0.001	1.053（1.028，1.077）

变量	β	SE	Wald χ²值	P值	OR（95%CI）
性别
男	0.415	0.238	3.026	0.082	1.514（0.949，2.416）
年龄	0.040	0.010	14.654	<0.001	1.040（1.019，1.062）
BMI	0.056	0.032	2.990	0.084	0.945（0.887，1.008）
高血压
有高血压	0.290	0.220	1.735	0.188	1.336（0.868，2.056）
糖尿病
有糖尿病	-0.219	0.219	2.761	0.097	0.694（0.452，1.068）
吸烟史
有吸烟史	0.113	0.218	0.268	0.605	1.119（0.730，1.715）
eGFR	-0.012	0.004	10.127	0.001	0.988（0.981，0.995）
LVEF	-0.037	0.008	19.200	<0.001	0.964（0.948，0.980）
CHA₂DS₂-VASc评分	0.210	0.052	16.061	<0.001	1.233（1.113，1.367）
SYNTAX评分	0.051	0.012	18.689	<0.001	1.053（1.028，1.077）

变量	β	SE	Wald χ²值	P值	OR（95%CI）
高血压
有高血压史	0.561	0.263	4.553	0.033	1.753（1.047，2.938）
LVEF	-0.039	0.011	13.629	<0.001	0.962（0.942，0.982）
CHA₂DS₂-VASc评分	0.191	0.063	9.187	0.002	1.210（1.070，1.369）
SYNTAX评分	0.028	0.013	4.626	<0.031	1.028（1.002，1.055）

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

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

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变量	全因死亡			非致死性心肌梗死
变量	SHR	95%CI	P值	SHR	95%CI	P值
SYNTAX评分	0.969	（0.945，0.993）	0.012	1.029	（0.989，1.070）	0.158
CHA₂DS₂-VASc评分	1.301	（1.133，1.294）	<0.001	1.289	（1.014，1.640）	0.038

变量	AUC差值	SE	95%CI	Z值	P值
SYNTAX评分vs. CHA₂DS₂-VASc评分	0.019 1	0.035 1	（-0.050，0.088）	0.543	0.587
SYNTAX评分vs.联合应用SYNTAX评分和CHA₂DS₂-VASc评分	0.046 9	0.018 6	（0.010，0.083）	2.000	0.046
CHA₂DS₂-VASc评分vs.联合应用SYNTAX评分和CHA₂DS₂-VASc评分	0.065 9	0.019 3	（0.028，0.099）	2.021	0.043

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