The Discussion Of The Predictive Value Of The Combined Assessment Of Hcy And GRACE Scores On Short-Term Prognosis In Patients With Acute Coronary Syndrome

Objective: Investigate the predictive value of the Hcy and the combined assessment of Hcy and GRACE scores on short-term prognosis by comparing the relationship between Hcy?GRACE score and combination of the two with recent prognosis in patients with ACS.Metheds: There were 90 patients diagnosed as ACS between January to June 2015 in the Second Hospital Affiliated to Hebei Medical University,including 57 cases with UA,(63.3%),13 cases with NSTEMI(14.4%),20 cases with STEMI(22.2%).Plasma Hcy was detected and GRACE score was calculated for the patients selected.MACE(myocardial infarction,again reascularization,cardiac death)?recurrence angina pectoris and heart failure were selected as end point events and the subjects were observed and followed up for 6 months.The patients were divided into event group and non-event group according to whether cardiac events happened or not within 6 months after discharge.Forecast value of three methods of cardiac events in patients with ACS in 6 months after discharge was concluded by comparing the Hcy and GRACE score respective and joint assessment.SPSS13.0 was used to analyze the experimental data,among which the measurement data is expressed with mean and standard deviation,continuous variables between groups which is normal distribution is analyzed by t-test,the count data is analyzed by X2-test,multiple factors is analyzed by Logistic regression.SPSS is used to draw the ROC curve,calculate and compare the area under the curve.The result taking P<0.05 as standard is statistically significant.Results: 1 Among the patients,there are 27 cases of cardiac events(10 cases of recurrence of angina pectoris,3 cases of myocardial infarction,9 cases of heart failure,4 cases of again reascularization,1 case of cardiac death)within 6 months.The patients are divided into event group,and non-event group,there is no statistical significance between two groups in age(63.15�10.77?59.63�7.31),gender(the proportion of men)(65.38%?58.69%),BMI(26.28�3.74 ? 25.31�3.87),diastolic blood pressure(76.08�10.33 ?80.30�9.66),heart rate(68.46�9.61?68.13�12.96)smoking history(68.41%?67.26%),hypertension history(46.15%?67.39%),history of diabetes(23.08%?30.43%),hyperlipidemia history(11.84%?21.74%),ALT(28.46�17.94?31.80�35.11),Scr(74.85�21.62?71.64�16.69),K+(4.01�0.33?3.99�0.42),blood glucose(5.49�3.33?5.39�1.22),and the incidence of the myocardial necrosis markers(30.76%?19.56%).2 Compared with non-event group,the systolic blood pressure(125.42�20.52 137.56�19.99)?history of cardiac insufficiency(73.08% 45.65%)?history of myocardial infarction(34.62% 13.04%)?hospitalization without coronary artery reperfusion treatment(including thrombolysis,PCI and CABG)(53.85% 58.70%)?ejection fraction(58.13�5.04 61.41�5.34)?the incidence of ST segment depression(?1mm)(42.31% 19.56%)?Hcy levels(16.29�9.56 10.89�5.28)and GRACE score(126.96�38.83 98.07�28.37)of the event group are different.The difference are statistically significant(P<0.05).3 Analysis the 90 patients as a whole through Logistic regression,the dependent variable depends on the end point event happen or not(not happen=0,happen=1),the independent variable include age?gender?BMI? systolic blood pressure?diastolic blood pressure?heart rate?smoking history?hypertension history?history of diabetes?hyperlipidemia history?ejection fraction?ALT?Scr?K+?the incidence of the myocardial necrosis markers?blood glucose ? history of cardiac insufficiency ? history of myocardial infarction?the incidence of ST segment depression(?1mm)?hospitalization without coronary artery reperfusion treatment(including thrombolysis,PCI and CABG)?Hcy levels and GRACE score.Finally two variables went into the regression equation,include Hcy and GRACE score,that is to say,Hcy and GRACE score are independent risk factors for cardiac events happened on the ACS patients discharged from hospital within 6 months.Among them,the score proportion of the recent end point event is 3.359 when Hcy rise a level,the score proportion of the recent end point event is 3.672 when GRACE score rise a level.Logistic regression equation can be calculated through Logistic regression analysis,that is logitP=-3.797+1.212Hcy+1.301 GRACE score.So as to form a new variable �union�.4 Draw the ROC curve of the occurence of cardiac events within 6 months in ACS patients predicted by Hcy?GRACE score and combination of the two through SPSS,determine and compare the AUC,AUC of Hcy is 0.656,GRACE score is 0.753,combination of the two is 0.783.Compare them with Z-test,there is no statistically significant about the difference.Conclusions:1 There is predictive value of Hcy levels?GRACE score and combination of the two on the occurence of the cardiac events within 6 months in ACS patients.2 Combined Hcy levels with GRACE score can not evaluate more accurately to predict the possibility of the occurence of cardiac events within 6 months in ACS patients.