| Objective:By following up the endpoint events within in-hospital and 1 year of the patients with acute coronary syndrome without ST-segment elevation(NSTE-ACS). To determine the risk factors which influence the near or future prognosis of patients with NSTE-ACS. To compare four risk stratification methods in the evaluation of prognosis in patients with NSTE-ACS.Background:Patients with NSTE-ACS occupy great proportion in all patients with acute coronary syndrome in our country.Because of great difference of clinical symptom and prognosis,we'd better take early risk stratification to those patients who are diagnosed as NSTE-ACS,set down pertinent treatment strategy,and improve the prognosis mostly.Cardiologist requires an easy risk stratification method which has great sensitivity and specificity relatively to evaluate the prognosis of those patients.Methods:1.We studied 197 consecutive patients admitted to our hospital with NSTE-ACS from Jan.2006 to Dec.2008.Of those patients, 134 patients had unstable angina (UA), 63 patients had myocardial infarction without ST-segment elevation(NSTEMI).we followed up the endpoint events(all-cause mortality or non-fatal myocardial infarction) within in-hospital and 1 year of the patients with NSTE-ACS.2.According to the result of following up,all patients were divided into 4 groups,15 patients with endpoint events within hospital,182 patients without endpoint events within hospital,33 patients with endpoint events after 1 year,164 patients without endpoint events after 1 year.we did single factor analysis,then we did multivariate Logistic regression in the meaning factors to filter risk factors which influence in-hospital and 1 year prognosis.3.The Thrombolysis In Myocardial Infarction (TIMI), The Platelet GlycoproteinⅡb /Ⅲa in Unstable Angina:Receptor Suppression Using Integrilin Therapy Trial (PURSUIT), Global Registry Of Acute Coronary Events (GRACE) risk scores were calculated and traditional American College Cardiology/American Heart Association (ACC/AHA) risk stratification was evaluated according to the baseline characteristics on admission. We described ROC curves about those four risk stratifications, and computed the areas under the curves,then compared the accuracy of those four risk stratification methods.Results:1.The incidences of endpoint events within duration of hospital and 1 year were 7.6% (death2.5%,MI5.1%) and 16.8%(death7.1%,MI9.6%) respectively.2.Multivariate logistic regression analysis showed that lower ejection fraction of left ventricle(OR=5.713;P=0.006),increased serocreatinine (OR=1.015;P=0.005),were associated with an increase of endpoint events within duration of hospital. Multivariate logistic regression analysis also showed that age(OR=1.105;P﹤0.001),lower ejection fraction of left ventricle(OR=5.063;P=0.007),increased serocreatinine(OR=1.021;P=0.001), and heart rates on admission (OR=1.033;P=0.016)were associated with an increase of endpoint events within 1 year.3.The accuracy that those four risk stratifications (TraditionalACC/AHA risk stratification,TIMI,PURSUIT,GRACE)predicted in-hospital and 1 year endpoint events in patients with NSTE-ACS tended to increase gradually, The accuracy of GRACE to predict in-hospital and 1 year endpoint events were(AUC:0.671, 95%Cl:0.534～0.807)and(AUC:0.725,95%Cl:0.641～0.810)respectively,both the sensitivity and the specificity of the GRACE risk score in 135 points which predicted 1 year endpoint events manifested good,the sensitivity and the specificity of GRACE were 0.600 and 0.830 respectively.4.The accuracy of GRACE to predict 1 year endpoint events were superior to TIMI risk score(P﹤0.05).The accuracy of PURSUIT and GRACE to predict 1 year endpoint events were superior to the tradition ACC/AHA risk stratification(P﹤0.05).Conclusions:1.lower ejection fraction of left ventricle and serocreainine levels are risk factors which can simultaneously influence the prognosis of the patients with NSTE-ACS within in-hospital and 1 year.2.The accuracy that both GRACE and PURSUIT predicted in-hospital and 1 year endpoint events in patients with acute coronary syndrome without ST-segment elevation manifests good. 3.The accuracy of GRACE risk score to predict 1 year endpoint events is superior to TIMI and the traditional ACC/AHA risk stratification. The accuracy of PURSUIT risk score to predict 1 year endpoint events is superior to the traditional ACC/AHA risk stratification.4.Both the sensitivity and the specificity of the GRACE risk score in 135 points which predicted 1 year endpoint events manifest good.Considering practicability and accuracy , GRACE risk score should be the first choice in clinic.
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