| BackgroundAs we all know,cardiovascular disease has become the leading cause of death of residents.Not only that,some studies suggest that the burden of cardiovascular disease will increase in the future,and acute myocardial infarction(AMI)is one of the acute and critical cases of cardiovascular disease.From intensive drug therapy to thrombolytic therapy to primary percutaneous coronary intervention(pPCI),the diagnosis and treatment of AMI is becoming more and more mature,but up to now,it is still a disease with high mortality.For the same AMI,the intraoperative risk,incidence of major adverse cardiovascular events(MACE)and mortality in pPCI may be different due to different age,sex and underlying diseases.With the deepening of understanding of AMI,people gradually realize that risk stratification is needed in the diagnosis and treatment of AMI.Accurate and efficient risk stratification is not only conducive to the prediction of the clinical outcome of patients,the evaluation of the condition,but also has a good guiding significance for the improvement of intraoperative preparation and in-hospital treatment measures.Although some risk stratification methods have been proposed for AMI,such as GRACE score,TIMI score,etc,the procedure of GRACE score is complicated,and some calculation tools are needed.The calculation of TIMI score is also complicated,and the score items and observation end points are different for different types of acute coronary syndrome,so it is not used for rapid risk stratification of patients before pPCI.CHA2DS2-VASc score is improved by Lip et al on the basis of CHADS2 score.It is easy to remember.At present,it is mainly used to evaluate the risk of thrombosis in patients with atrial fibrillation and guide anticoagulation therapy in patients with atrial fibrillation.At the same time,in clinical practice,the value of CHA2DS2-VASc score in risk stratification of patients with AMI has been gradually recognized.ObjectiveThis study is mainly aimed at AMI patients receiving primary percutaneous coronary intervention,to study the relationship between CHA2DS2-VASc score and MACE of AMI patients during hospitalization,and to explore the value of CHA2DS2-VASc score in risk stratification.MethodsA total of 327 AMI patients who received primary percutaneous coronary intervention in Henan Provincial people's Hospital from October 2017 to December 2018 were studied.Record the general conditions and clinical data of the patients in detail,including name,sex,age,history of hypertension,history of diabetes,history of schemic stroke,history of transient ischemic attack(TIA),history of congestive heart failure(CHF),history of thromboembolic diseases,history of smoking,history of drinking,history of percutaneous coronary intervention(PCI),family history of coronary heart disease(CHD),body mass index(BMI),serum creatinine,white blood cell,total cholesterol,admission systolic blood pressure(SBP),peak creatine kinase isoenzyme(CK-MB),left ventricular ejection fraction(LVEF),as well as intraoperative and in-hospital conditions,including coronary angiography,incidence of MACE in hospital.After collecting the required data,each patient was scored by CHA2DS2-VASc,and all patients were divided into groups according to whether MACE occurred in the hospital.To judge whether CHA2DS2-VASc score affects MACE in hospital by univariate analysis and multivariate analysis.After it was confirmed that the CHA2DS2-VASc score significantly affected the in-hospital MACE,using receiver operating characteristic curve(ROC)to test the predictive value of CHA2DS2-VASc score on in-hospital MACE in AMI patients treated with pPCI,and to find the critical point for screening high-risk AMI patients.AMI patients were divided into groups according to the critical point,and the differences of baseline data,emergency intervention and in-hospital MACE between the two groups were compared to explore the feasibility of using the critical point to screen high-risk AMI patients.Results1.A total of 327 patients with AMI who received pPCI treatment were enrolled in this study.There were 236 patients(72.17%)without MACE and 91 patients(27.83%)with MACE in hospital.2.Univariate analysis shows that:The CHA2DS2-VASc score,peak CK-MB and serum creatinine in the MACE group were significantly higher than those in the non-MACE group(P<0.05).The history of smoking,drinking and admission SBP in the MACE group were significantly lower than those in the non-MACE group(P<0.05).There was no significant difference in STEMI proportion,PCI history,LVEF,BMI,leukocyte and total cholesterol between the two groups(P>0.05).3.Binary Logistic regression analysis showed that:CHA2DS2-VASc score,admission SBP,peak CKMB and serum creatinine had significant effects on the occurrence of MACE in hospital.4.The CHA2DS2-VASc score and the ROC curve of the in-hospital MACE show that:The area under ROC curve is 0.724 and 95%confidence interval is(0.660,0.788);ROC curve indicates that the critical point of CHA2DS2-VASc score for predicting MACE in hospital is 3.5;because the CHA2DS2-VASc score is an integer,it is suggested that patients with AMI can be divided into groups according to CHA2DS2-VASc score<4 and? 4;there were 224 cases(68.50%)with CHA2DS2-VASc score<4 and 103 cases(31.50%)with CHA2DS2-VASc score?4.5.Comparison of baseline data between CHA2DS2-VASc score? 4 group and<4 group:The proportion of age? 65,female,stroke/TIA history,CHF history,hypertension history,diabetes history and peak CK-MB in the group with CHA2DS2-VASc score?4 were higher than those in the group with CHA2DS2-VASc score<4,and the difference was statistically significant(P<0.05).The proportion of drinking history,smoking history,CHD family history,BMI and LVEF in the group with CHA2DS2-VASc score? 4 was lower than that in the group with CHA2DS2-VASc score<4,and the difference was statistically significant(P<0.05).6.The comparison of emergency intervention between CHA2DS2-VASc score?4 group and<4 group:There was significant difference in the distribution of infarct-related vessels between the two groups,and the door to ballon time and the proportion of multi-vessel lesions in the group with CHA2DS2-VASc score?4 was significantly higher than that in the group with CHA2DS2-VASc score<4(P<0.05).There was no significant difference in the proportion of stent implantation between the two groups(P>0.05).7.Comparison of in-hospital MACEs between CHA2DS2-VASc score? 4 group and<4 group:The incidence of total MACE,cardiogenic death,cardiogenic shock and malignant arrhythmia in the group with CHA2DS2-VASc score? 4 was higher than that in the group with CHA2DS2-VASc score<4(P<0.05),but there was no significant difference in the incidence of myocardial reinfarction and stroke in the group with CHA2DS2-VASc score?4 and in the group with CHA2DS2-VASc score<4(P>0.05).ConclusionThe use of CHA2DS2-VASc score for risk stratification of AMI patients has a certain value.It can be considered that CHA2DS2-VASc score can be used for rapid risk stratification of AMI patients receiving primary percutaneous coronary intervention.AMI patients with CHA2DS2-VASc score?4 can be regarded as high risk patients. |
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