CHADS_2评分及其衍生评分对冠状动脉病变严重程度的预测价值
|
摘要
目的探讨心房颤动(房颤)评分系统CHADS_2及其衍生评分对冠状动脉(冠脉)病变严重程度的预测价值。方法选择疑诊冠心病并行冠状动脉造影检查的连续病例542例,根据患者临床资料计算其CHADS_2、CHA_2DS_2-VASc和CHA_2DS_2-VASc-HSF评分,根据其冠状动脉造影结果计算其SYNTAX评分,评价病变严重程度,根据SYNTAX评分将患者分为轻中度病变506例(轻中度病变组)与重度病变36例(重度病变组),记录两组的各项生化指标,采用二元Logistic回归分析患者冠脉病变严重程度的危险因素,采用受试者工作特征(ROC)曲线比较三种评分对冠脉病变严重程度的预测价值。结果糖尿病史(OR为3. 401,95%CI 1. 214～9. 527,P=0. 020)及CHA_2DS_2-VASc-HSF评分(OR为2. 100,95%CI 1. 163～3. 792,P=0. 014)是冠脉病变严重程度的独立危险因素。CHADS_2、CHA_2DS_2-VASc和CHA_2DS_2-VASc-HSF评分均与SYNTAX评分呈正相关(r分别为0. 111、0. 218、0. 232,P分别为0. 009、0. 000、0. 000)。三种评分预测重度冠脉病变的受试者工作特征曲线下面积(AUC)分别为0. 715、0. 732、0. 781,CHA_2DS_2-VASc-HSF评分的最佳临界值为4. 5分,敏感度为80. 6%,特异度为63. 0%[AUC为0. 781,95%CI 0. 721～0. 842,P=0. 000]。结论 CHADS_2评分及其衍生评分均可作为预测重度冠脉病变有价值的指标,其中CHA_2DS_2-VASc-HSF评分> 4. 5分时预测价值最大。
Objective To explore the value of CHADS_2,CHA_2 DS_2-VASc,and CHA_2 DS_2-VASc-HSF scores for prediction of coronary artery lesion severity. Methods Totally 542 coronary heart disease patients who underwent coronary angiography were selected. According to the clinical data,CHADS_2,CHA_2 DS_2-VASc,and CHA_2 DS_2-VASc-HSF scores were calculated. SYNTAX score was calculated based on the results of CAG. Patients were divided into 2 groups : the mild& moderate lesion group( n = 506) and severe lesion group( n = 36) according to SYNTAX score. The biochemical indexes of the patients in the two groups were measured and compared to identify the risk factors of coronary artery lesion severity by using binary Logistic regression. Furthermore,AUC was calculated to access the predictive ability of three kinds of scores by using ROC curve. Methods Type 2 diabetes mellitus( OR = 3. 401,95% CI 1. 214-9. 527,P = 0. 020) and CHA_2 DS_2-VASc-HSF score( OR = 2. 100,95% CI 1. 163-3. 792,P = 0. 014) were the independent risk factors for coronary artery lesion severity. The CHADS_2,CHA_2 DS_2-VASc,and CHA_2 DS_2-VASc-HSF scores were positively correlated with the coronary artery lesion severity( r = 0. 111,0. 218,0. 232 respectively; P = 0. 009,0. 000,0. 000,respectively).For prediction of severe coronary artery lesion,the AUC of CHADS_2,CHA_2 DS_2-VASc and CHA_2 DS_2-VASc-HSF score was0. 715,0. 732,and 0. 781,the optimal cut-off value of CHA_2 DS_2-VASc-HSF score was 4. 50 with a sensitivity of 80. 6%and a specificity of 63. 0%( AUC: 0. 781,95% CI: 0. 721-0. 842,P = 0. 000). Conclusions Type 2 diabetes mellitus and CHA_2 DS_2-VASc-HSF score are the independent risk factors for the coronary artery lesion severity. Three kinds of scores are positively correlated with SYNTAX score. CHADS_2,CHA_2 DS_2-VASc and CHA_2 DS_2-VASc-HSF score can be used as the valuable indicators of severe coronary artery lesion,and the predictive value of CHA_2 DS_2-VASc-HSF score >4. 5 is the largest.
Objective To explore the value of CHADS_2,CHA_2 DS_2-VASc,and CHA_2 DS_2-VASc-HSF scores for prediction of coronary artery lesion severity. Methods Totally 542 coronary heart disease patients who underwent coronary angiography were selected. According to the clinical data,CHADS_2,CHA_2 DS_2-VASc,and CHA_2 DS_2-VASc-HSF scores were calculated. SYNTAX score was calculated based on the results of CAG. Patients were divided into 2 groups : the mild& moderate lesion group( n = 506) and severe lesion group( n = 36) according to SYNTAX score. The biochemical indexes of the patients in the two groups were measured and compared to identify the risk factors of coronary artery lesion severity by using binary Logistic regression. Furthermore,AUC was calculated to access the predictive ability of three kinds of scores by using ROC curve. Methods Type 2 diabetes mellitus( OR = 3. 401,95% CI 1. 214-9. 527,P = 0. 020) and CHA_2 DS_2-VASc-HSF score( OR = 2. 100,95% CI 1. 163-3. 792,P = 0. 014) were the independent risk factors for coronary artery lesion severity. The CHADS_2,CHA_2 DS_2-VASc,and CHA_2 DS_2-VASc-HSF scores were positively correlated with the coronary artery lesion severity( r = 0. 111,0. 218,0. 232 respectively; P = 0. 009,0. 000,0. 000,respectively).For prediction of severe coronary artery lesion,the AUC of CHADS_2,CHA_2 DS_2-VASc and CHA_2 DS_2-VASc-HSF score was0. 715,0. 732,and 0. 781,the optimal cut-off value of CHA_2 DS_2-VASc-HSF score was 4. 50 with a sensitivity of 80. 6%and a specificity of 63. 0%( AUC: 0. 781,95% CI: 0. 721-0. 842,P = 0. 000). Conclusions Type 2 diabetes mellitus and CHA_2 DS_2-VASc-HSF score are the independent risk factors for the coronary artery lesion severity. Three kinds of scores are positively correlated with SYNTAX score. CHADS_2,CHA_2 DS_2-VASc and CHA_2 DS_2-VASc-HSF score can be used as the valuable indicators of severe coronary artery lesion,and the predictive value of CHA_2 DS_2-VASc-HSF score >4. 5 is the largest.
引文
[1]Mack M,Baumgarten H,Lytle B. Why surgery won the SYNTAXtrial and why it matters[J]. J Thorac Cardiovasc Surg,2016,152(5):1237-1240.
[2]Levine GN,Bates ER,Blankenship JC,et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report ofthe American College of Cardiology Foundation/American HeartAssociation Task Force on Practice Guidelines and the Society forCardiovascular Angiography and Interventions[J]. J Am Coll Car-diol,2011,58(24):e44-e122.
[3]Cetin M,Cakici M,Zencir C,et al. Prediction of coronary arterydisease severity using CHADS2and CHA2DS2-VASc scores and anewly defined CHA2DS2-VASc-HS score[J]. Am J Cardiol,2014,113(6):950-956.
[4]Leening MJ,Ferket BS,Steyerberg EW,et al. Sex differences inlifetime risk and first manifestation of cardiovascular disease:pro-spective population based cohort study[J]. BMJ,2014,349:g5992.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):2-67.
[6]GBD 2015 Mortality and Causes of Death Collaborators. Global,regional,and national life expectancy,all-cause mortality,andcause-specific mortality for 249 causes of death,1980-2015:a sys-tematic analysis for the Global Burden of Disease Study 2015[J].Lancet,2016,388(10053):1459-1544.
[7]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2017》概要[J].中国循环杂志,2018,33(1):1-8.
[8]Kirigaya H,Kato S,Gyotoku D,et al. Higher CHADS2score isassociated with impaired coronary flow reserve:A study usingphase contrast cine magnetic resonance imaging[J]. Int J Cardiol,2016,221:800-805.
[9] Funabashi N,Uehara M,Takaoka H,et al. The CHA2DS2-VAScscore predicts 320-slice CT-based coronary artery plaques and>50%stenosis in subjects with chronic and paroxysmal atrial fibrilla-tion[J]. Int J Cardiol,2014,172(1):e234-e237.
[10]Ntaios G,Lip GY,Makaritsis K,et al. CHADS(2),CHA(2)S(2)DS(2)-VASc,and long-term stroke outcome in patients with-out atrial fibrillation[J]. Neurology,2013,80(11):1009-1017.
[11] Ross R. Atherosclerosis--an inflammatory disease[J]. N Engl JMed,1999,340(2):115-126.
[12] Crandall MA,Horne BD,Day JD,et al. Atrial fibrillation andCHADS2risk factors are associated with highly sensitive C-reactiveprotein incrementally and independently[J]. Pacing Clin Electro-physiol,2009,32(5):648-652.
[13] Potpara TS,Polovina MM,Djikic D,et al. The association ofCHA2DS2-VASc score and blood biomarkers with ischemic strokeoutcomes:the Belgrade stroke study[J]. PLo S One,2014,9(9):e106439.
[14]李月蕊,刘洋,张辉,等.评价房颤CHADS2评分及其衍生评分对冠心病及其严重程度的预测价值[J].解放军医学院学报,2015,36(4):305-308,317.
[2]Levine GN,Bates ER,Blankenship JC,et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report ofthe American College of Cardiology Foundation/American HeartAssociation Task Force on Practice Guidelines and the Society forCardiovascular Angiography and Interventions[J]. J Am Coll Car-diol,2011,58(24):e44-e122.
[3]Cetin M,Cakici M,Zencir C,et al. Prediction of coronary arterydisease severity using CHADS2and CHA2DS2-VASc scores and anewly defined CHA2DS2-VASc-HS score[J]. Am J Cardiol,2014,113(6):950-956.
[4]Leening MJ,Ferket BS,Steyerberg EW,et al. Sex differences inlifetime risk and first manifestation of cardiovascular disease:pro-spective population based cohort study[J]. BMJ,2014,349:g5992.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):2-67.
[6]GBD 2015 Mortality and Causes of Death Collaborators. Global,regional,and national life expectancy,all-cause mortality,andcause-specific mortality for 249 causes of death,1980-2015:a sys-tematic analysis for the Global Burden of Disease Study 2015[J].Lancet,2016,388(10053):1459-1544.
[7]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2017》概要[J].中国循环杂志,2018,33(1):1-8.
[8]Kirigaya H,Kato S,Gyotoku D,et al. Higher CHADS2score isassociated with impaired coronary flow reserve:A study usingphase contrast cine magnetic resonance imaging[J]. Int J Cardiol,2016,221:800-805.
[9] Funabashi N,Uehara M,Takaoka H,et al. The CHA2DS2-VAScscore predicts 320-slice CT-based coronary artery plaques and>50%stenosis in subjects with chronic and paroxysmal atrial fibrilla-tion[J]. Int J Cardiol,2014,172(1):e234-e237.
[10]Ntaios G,Lip GY,Makaritsis K,et al. CHADS(2),CHA(2)S(2)DS(2)-VASc,and long-term stroke outcome in patients with-out atrial fibrillation[J]. Neurology,2013,80(11):1009-1017.
[11] Ross R. Atherosclerosis--an inflammatory disease[J]. N Engl JMed,1999,340(2):115-126.
[12] Crandall MA,Horne BD,Day JD,et al. Atrial fibrillation andCHADS2risk factors are associated with highly sensitive C-reactiveprotein incrementally and independently[J]. Pacing Clin Electro-physiol,2009,32(5):648-652.
[13] Potpara TS,Polovina MM,Djikic D,et al. The association ofCHA2DS2-VASc score and blood biomarkers with ischemic strokeoutcomes:the Belgrade stroke study[J]. PLo S One,2014,9(9):e106439.
[14]李月蕊,刘洋,张辉,等.评价房颤CHADS2评分及其衍生评分对冠心病及其严重程度的预测价值[J].解放军医学院学报,2015,36(4):305-308,317.