The Predictive Value Of Combining HEART Score And Si For The Occurrence Of Mace In Patients With Non-ST-segment Elevation Acute Coronary Syndrome

ObjectiveTo study the value of HEART score and shock index(SI)in predicting the risk of getting major adverse cardiac events(MACE)in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)and their prognosis benefit.MethodsFrom August 2016 to December 2018,patients with coronary angiography examination NSTE-ACS who met the standard were collected from the emergency department of our hospital.The endpoint was follow-up to MACE within one year.MACE was defined:all-cause death,target lesion revascularization(TLR)or target vessel revascularization(TVR),non-fatal myocardial infarction and stroke.1.Based on whether MACE occurred during one year,the NSTE-ACS patients were determined.Patients were seperated into the occurrence group of MACE and the non-occurrence MACE group.HEART score was calculated according to history,electrocardiogram(ECG),age,risk factors,troponin and differentiated into low risk group(0～3 score),medium risk group(4～6 score)and high risk group(7～10score).SI was calculated according to pulse and systolic blood pressure ratio.HEART risk stratification subgroup analysis based on 0.578 the median value of SI.Comparison of basic clinical data and prognosis between groups.2.The correlation between HEART score,SI and other clinical parameters was analyzed by Spearman correlation analysis.Kaplan-Meier survival curve was performed to analyze the difference of MACE in the groups divided according to the HEART score and the union HEART score and SI.Logistic and COX regression analysis were used to evaluate the independent correlation of the severity of coronary artery lesions and MACE of patients with NSTE-ACS.Then,we also operated receiver operating characteristic curves(ROC)to evaluate the cut-off value of HEART score and SI for predicting MACE during follow-up period.Results1.In this study,a total of 302 patients.Patients included were divided into three groups according HEART score:low risk(n=55,18.21%),medium risk(n=173,57.29%),high risk(n=74,24.50%),resulted in 1.81%,12.72%,29.73%risk of MACE.Patients were categorized into six groups consult the HEART score and the median value of SI:Low HEART-Low SI(n=26,8.61%),Low HEART-High SI(n=29,9.60%),Medium HEART-Low SI(n=95,31.45%),Medium HEART-High SI(n=78,25.83%),High HEART-Low SI(n=32,10.60%),High HEART-High SI(n=42,13.91%),resulted in0%,3.45%,10.53%,15.38%,18.75%,38.10%risk of MACE.2.During the one year follow-up period,a total of 45(14.90%)patients had a MACE.MACE group had a higher median value of HEART score(5 vs 7),higher median value of SI(0.57 vs 0.61),higher age and pulse,longer hospitalization days,higher rates Killip classification≥2,poorer cardiac function(higher NT-pro BNP,lower LVEF,bigger LVEDV),more severe coronary lesions(higher Gensini score,higher multiple coronary lesions),P<0.05.3.Spearman correlation analysis indicated:HEART score was positively correlated with age,SI,Gensini score,NT-pro BNP,CK-MB and was negatively with LVEF,P<0.001.SI was positively correlated with NT-pro BNP and neutrophile and was negatively with LVEF,P<0.05.4.Logistic regression analysis revealed:sex(P=0.001),diabetes mellitus(P=0.020)were the independent influencing factors of multiple coronary artery lesions.HEART score and SI were not found to be independent influencing factors of multiple coronary artery lesions,P>0.05.HEART score(P=0.027)and neutrophile(P=0.025)were the independent influencing factors of preoperative TIMI grade≤2.SI was not found to be independent influencing factor of preoperative TIMI grade≤2,P>0.05.5.Correspondingly,Kaplan-Meier survival analysis showed:the cumulative survival rate of the high risk group(Log-Rankχ~2=21.365,P<0.001)and the High HEART-High SI group(Log-Rankχ~2=29.582,P<0.001)were significantly decreased.6.A multivariate COX regression model indicated:independent predictors of MACE included age(HR=1.044,95%CI 1.004-1.086,P=0.030),pulse(HR=1.051,95%CI1.014-1.088,P=0.006),HEART score(HR=1.292,95%CI 1.004-1.663,P=0.046)and LVEF(HR=0.952,95%CI 0.914-0.991,P=0.018).SI was not found to be independent influencing factor of MACE,P>0.05.7.ROC analysis was conducted to determine the prediction value of combining HEART score and SI for the occurrence of MACE.Combining HEART score and SI yielded a much more valuable predictive value(AUC=0.784,95%CI 0.719-0.850,P<0.001),with 84.4%sensitivity and 63.8%specificity.HEART score yielded AUC=0.765,SI yielded AUC=0.641.Conclusion1.HEART score was a high predictive value for the prognosis of patients with NSTE-ACS in emergency department.High risk group in HEART socre had more likely the probability of MACE occurrence.2.Combining HEART score and SI yielded a much more valuable predictive.High HEART-High SI group had higher risk of MACE outcomes.3.HEART score was independent influencing factor of MACE occurrence.