2017 年第 9 期 第 12 卷

不同风险评分对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入术后发生院内大出血的预测能力比较

Values of different risk scores in prediction of inhospital major bleeding after primary percutaneous coronary intervention treating acute STsegment elevation myocardial infarction

作者：周生辉，刘然，郑文，聂绍平

英文作者：Zhou Shenghui Liu Ran Zheng Wen Nie Shaoping

单位：100029首都医科大学附属北京安贞医院急诊危重症中心

英文单位：Emergency and Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性ST段抬高型心肌梗死；直接经皮冠状动脉介入；风险评分；大出血

英文关键词：AcuteSTsegmentelevationmyocardialinfarction；Primarypercutaneouscoronaryintervention；Riskscore；Majorbleeding

• 摘要：

• 目的比较CRUSADE评分、ACTION评分和ACUITY-HORIZONS评分对急性ST段抬高型心肌梗死（STEMI）患者接受直接经皮冠状动脉介入（PPCI）术后发生院内大出血的预测能力。方法回顾性入选2014年11月至2016年1月于首都医科大学附属北京安贞医院接受PPCI的急性STEMI患者1 080例。对每例患者进行CRUSADE评分、ACTION评分和ACUITY-HORIZONS评分。将院内大出血事件定义为出血学术研究会3型及5型出血。采用Hosmer-Lemeshow拟合优度检验和受试者工作特征曲线下面积(AUC)评价3种评分对院内大出血的预测能力，DeLong检验比较各评分AUC值。结果1 080例患者中共19例（1.8%）发生院内大出血。总人群中，CRUSADE评分、ACTION评分、ACUITY-HORIZONS评分的Hosmer-Lemeshow拟合优度检验均满意（均P＞0.05），AUC值分别为0.906、0.909、0.747。在经桡动脉（985例）和股动脉（95例）途径行经皮冠状动脉介入（PCI）亚组中，3种评分Hosmer-Lemeshow拟合优度检验均满意（均P＞0.05）。在经桡动脉途径行PCI亚组中，3种评分AUC值分别为0.915、0.896、0.805。在股动脉途径行PCI亚组中，3种评分AUC值分别为0.864、0.899、0.678。在总人群、经桡动脉及股动脉途径行PCI亚组中，CRUSADE评分及ACTION评分AUC值比较差异均无统计学意义（均P＞0.05），二者AUC值均优于ACUITY-HORIZONS评分（均P＜0.05）。结论在接受PPCI的急性STEMI人群中，无论经桡动脉还是股动脉途径行PCI，CRUSADE评分和ACTION评分对院内大出血的预测能力相当，均优于ACUITY-HORIZONS评分。

• ObjectiveTo assess abilities of CRUSADE, ACTION, and ACUITY-HORIZONS scores in predicting inhospital major bleeding after primary percutaneous coronary intervention（PPCI） in patients with acute ST-segment elevation myocardial infarction（STEMI）. MethodsA total of 1 080 patients with acute STEMI who underwent PPCI from November 2014 to January 2016 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. Scores of CRUSADE, ACTION and ACUITY-HORIZONS were calculated in all patients. In-hospital major bleeding was defined as Bleeding Academic Research Consortium type 3 and type 5. Predictive abilities of CRUSADE, ACTION and ACUITY-HORIZONS were assessed by the Hosmer-Lemeshow goodness of fit test and the receiver operating characteristic curve; values of the area under receiver operating characteristic curve（AUC） were analyzed by the DeLong test. ResultsThe incidence of in-hospital major bleeding was 1.8%(19/1 080). Scores of CRUSADE, ACTION and ACUITYHORIZONS showed optimistic goodness-of-fit in Hosmer-Lemeshow test（P＞0.05）; the AUC values were 0.906, 0.909 and 0.747, respectively. In transradial and transfemoral PCI subgroups, 3 kinds of risk scores had good HosmerLemeshow goodness-of-fit（P＞0.05）; the AUC values were 0.915, 0.896, 0.805 in transradial PCI subgroup and 0.864, 0.899, 0.678 in transfemoral PCI subgroup, respectively. In transradial PCI subgroup and transfemoral PCI subgroups, AUC showed no significant difference between CRUSADE and ACTION（P＞0.05）; AUC values of CRUSADE and ACTION were significantly superior to the AUC value of ACUITY-HORIZONS（P＜0.05）. ConclusionCRUSADE and ACTION can equally predict inhospital major bleeding in STEMI patients after PPCI and their predictive ability is superior to that of ACUITY-HORIZONS.