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目的探讨左室射血分数(left ventricular ejection fraction,LVEF)和全球急性冠状动脉事件注册(globalregistry of acute coronary events,GRACE)评分对急性冠状动脉综合征(acute coronary syndrome,ACS)患者住院期间发生主要不良心血管事件(major adverse cardiovascular events,MACE)的预测价值。方法 ACS患者325例,根据LVEF水平四分位数分成Q1～Q4组,根据GRACE积分将患者分为低危组、中危组与高危组。住院期间进行常规治疗,观察治疗后发生MACE的情况。结果低危组、中危组与高危组LVEF比较差异均有统计学意义(P<0.01);Q1～Q4组GRACE分值分别为123.51±26.94,113.41±24.18,109.75±31.69及111.68±29.93,Q1组与Q3,Q4组间比较差异有统计学意义(P<0.05);ACS患者LVEF与GRACE评分呈负相关(r=-0.248,P<0.01);住院期间治疗后发生MACE者18例(5.5%);ROC分析基线GRACE评分对ACS患者住院期间发生MACE的AUC为0.811(SE=0.064,95%CI:0.686～0.936,P<0.01);ROC分析基线LVEF对ACS患者住院期间发生MACE的AUC为0.806(SE=0.073,95%CI:0.663～0.950,P<0.01),LVEF和GRACE评分的AUC在预测ACS患者住院期间发生MACE的价值上差异无统计学意义(P>0.05)。结论 LVEF与GRACE对ACS患者住院期间危险分层和预测MACE有重要价值。
Objective To investigate the relationship between left ventricular ejection fraction (LVEF) and globalregistry of acute coronary events (GRACE) scores in patients with acute coronary syndrome (ACS) Predictive value of major adverse cardiovascular events (MACE). Methods A total of 325 ACS patients were divided into four groups according to the LVEF quartile. The patients were divided into low risk group, moderate risk group and high risk group according to GRACE score. During hospitalization, routine treatment was performed to observe the occurrence of MACE after treatment. Results There were significant differences in LVEF between low-risk group, intermediate-risk group and high-risk group (P <0.01). The GRACE scores of Q1 ~ Q4 group were 123.51 ± 26.94, 113.41 ± 24.18, 109.75 ± 31.69 and 111.68 ± 29.93, (P <0.05). There was a negative correlation between LVEF and GRACE scores in ACS patients (r = -0.248, P <0.01). There were 18 patients with MACE after hospitalization 5.5%). The ROC analysis showed that the baseline AUC of MACE was 0.811 (SE = 0.064, 95% CI: 0.686-0.936, P <0.01). The baseline LVEF was associated with MACE The AUC was 0.806 (SE = 0.073, 95% CI: 0.663-0.950, P <0.01). The AUC of LVEF and GRACE scores had no significant difference in predicting MACE during hospitalization among ACS patients (P> 0.05). Conclusions LVEF and GRACE have important value in risk stratification and MACE prediction in hospitalized patients with ACS.