孙号众,刘明,胡昊,吴佳纬,余晓凡,陈鸿武,华锦胜,马礼坤

• 1:安徽医科大学附属省立医院心血管内科

摘要(Abstract)：

目的 评价ACEF评分及改良ACEF(mACEF)评分对冠状动脉严重钙化行冠状动脉旋磨术并置入药物洗脱支架患者临床预后的预测价值。方法 纳入2017年1月至2020年7月安徽医科大学附属省立医院冠状动脉造影显示冠状动脉严重钙化，行冠状动脉旋磨术并成功置入药物洗脱支架的患者226例，对其进行术后1年的随访，排除失访及资料缺失患者，最终纳入206例患者。观察终点是1年随访期间的主要不良心血管事件（MACE，包括心原性死亡、再发心肌梗死、靶血管血运重建）。结果 206例患者术后随访1年，根据是否发生MACE分为MACE组（35例）和非MACE组（171例）。按ACEF评分分为低分组（ACEF评分<1.12分，70例）、中分组（ACEF评分1.12～1.44分，68例）和高分组（ACEF评分>1.44分，68例），1年后MACE发生率低分组与中分组[3例（4.3%）比13例（19.1%）,P=0.007]、高分组[3例（4.3%）比19例（27.9%）,P<0.001]分别比较，差异均有统计学意义，但中分组与高分组比较，差异无统计学意义（P=0.225）。按mACEF评分分为低分组（mACEF评分<1.21分，70例）、中分组（mACEF评分1.21～2.79分，68例）和高分组（mACEF评分>2.79,68例），1年后MACE发生率高分组与中分组[21例（30.9%）比9例（13.2%）,P=0.013]、低分组[21例（30.9%）比5例（7.1%）,P<0.001]分别比较，差异均有统计学意义，但中分组与低分组比较，差异无统计学意义（P=0.236）。ACEF评分受试者工作特征（ROC）曲线下面积分别为0.698(95%CI 0.631～0.760)，敏感度80.00%，特异度53.22%。mACEF评分ROC曲线下面积为0.720(95%CI 0.654～0.781)，敏感度74.29%，特异度62.57%。ACEF评分和mACEF评分预测价值之间比较差异无统计学意义（P=0.539）。结论 ACEF评分和mACEF评分是冠状动脉严重钙化患者旋磨术后置入药物洗脱支架的短期临床疗效预测的有效指标，但两个评分系统对此类患者短期临床预后的预测价值差异无统计学意义。

关键词(KeyWords)： ACEF评分;冠状动脉;血管钙化;旋磨术

Abstract:

Keywords:

基金项目(Foundation): 安徽省自然科学基金项目（2008085QH354）

作者(Author): 孙号众,刘明,胡昊,吴佳纬,余晓凡,陈鸿武,华锦胜,马礼坤

参考文献(References)：

• [1]葛均波，王伟民，霍勇.冠状动脉内旋磨术中国专家共识[J].中国介入心脏病学杂志，2017,25(2):61-66.
• [2] Strauss HW, Nakahara T, Narula N, et al. Vascular calcification:the evolving relationship of vascular calcification to major acute coronary events[J]. J Nucl Med, 2019, 60(9):1207-1212.
• [3] Kobayashi Y, Teirstein P, Linnemeier T, et al.Rotational atherectomy(stentablation)in a lesion with stent underexpansion due to heavily calcified plaque[J]. Catheter Cardiovasc Interv,2001,52(2):208-211.
• [4] Khattab AA, Otto A, Hochadel M, et al. Drug-eluting stents versus bare metal stents following rotational atherectomy for heavily calcified coronary lesions:late angiographic and clinical followup results[J]. J Interv Cardiol,2007,20(2):100-106.
• [5] Liu W, Zhang Y, Yu CM, et al. Current understanding of coronary artery calcification[J]. J Geriatr Cardiol,2015,12(6):668-675.
• [6]《冠状动脉钙化病变诊治中国专家共识》专家组.冠状动脉钙化病变诊治中国专家共识（2021版）[J].中国介入心脏病学杂志，2021,29(5):251-259.
• [7] Nicoll R, Wiklund U, Zhao Y, et al. Gender and a g e effects on risk factor-based prediction of coronary artery calcium in symptomatic patients:a Euro-CCAD study[J].Atherosclerosis,2016,252:32-39.
• [8] Bensenor IM, Goulart AC, Santos IS, et al. Association between a healthy cardiovascular risk factor profile and coronary artery calcium score:results from the Brazilian longitudinal study of adult health(ELSA-Brasil)[J]. Am Heart J,2016,174:51-59.
• [9] Ranucci M, Castelvecchio S, Menicanti L, et al. Risk of assessing mortality risk in elective cardiac operations:age,creatinine, ejection fraction, and the law of parsimony[J].Circulation,2009,119(24):3053-3061.
• [10] Farooq V, Head SJ, Kappetein AP,et al. Widening clinical applications of the SYNTAX score[J]. Heart,2014,100(4):276-287.
• [11] Pyxaras SA, Mangiacapra F, Wijns W, et al. ACEF and clinical SYNTAX score in the risk stratification of patients with heavily calcified coronary stenosis undergoing rotational atherectomy with stent implantation[J]. Catheter Cardiovasc Interv,2014,83(7):1067-1073.
• [12] Capodanno D, Caggegi A, Miano M,et al. Global risk classification and clinical SYNTAX(synergy between percutaneous coronary intervention with TAXUS and cardiac surgery)score in patients undergoing percutaneous or surgical left main revascularization[J].JACC Cardiovasc Interv,2011,4(3):287-297.
• [13]高国峰，徐晗，王虹剑，等. SYNTAX评分、ACEF评分及衍生评分在急诊冠心病介入中对无复流的预测价值研究[J].中国分子心脏病学杂志，2020,20(3):3361-3366.
• [14] Capodanno D, Marcantoni C, Ministeri M,et al. Incorporating glomerular filtration rate or creatinine clearance by the modification of diet in renal disease equation or the Cockcroft-Gault equations to improve the global accuracy of the age, creatinine, ejection fraction(ACEF)score in patients undergoing percutaneous coronary intervention[J].Int J Cardiol,2013,168(1):396-402.
• [15] Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine[J]. Nephron,1976,16(1):31-41.
• [16] Arguelles W, Llabre MM, Penedo FJ,et al. Relationship of change in traditional cardiometabolic risk factors to change in coronary artery calcification among individuals with detectable subclinical atherosclerosis:the multi-ethnic study of atherosclerosis[J]. Int J Cardiol,2014,174(1):51-56.
• [17] Tanigawa J, Barlis P, Di Mario C. Heavily calcified coronary lesions preclude strut apposition despite high pressure balloon dilatation and rotational atherectomy-In-vivo demonstration with optical coherence tomography[J]. Circ J,2008,72(1):157-160.
• [18] Sakakura K, Funayama H, Taniguchi Y, et al. The incidence of slow flow after rotational atherectomy of calcified coronary arteries:a randomized study of low speed versus high speed[J].Catheter Cardiovasc Interv,2017,89(5):832-840.
• [19] Capodanno D, Tamburino C. Integrating the synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery(SYNTAX)score into practice:use, pitfalls, and new directions[J]. Am Heart J,2011,161(3):462-470.
• [20] Biondi-Zoccai G, Romagnoli E, C a sta gno D,e t a l. Simplifying clinical risk prediction for percutaneous coronary intervention of bifurcation lesions:the case for the ACEF(age, creatinine, ejection fraction)score[J].EuroIntervention,2012,8(3):359-367.
• [21] Wykrzykowska JJ, Garg S, Onuma Y, et al. Value of age,creatinine, and ejection fraction(ACEF score)in assessing risk in patients undergoing percutaneous coronary interventions in the ‘All-Comers’ LEADERS trial[J]. Circ Cardiovasc Interv,2011,4(1):47-56.
• [22] Kalayci A, Oduncu V, Gecmen C, et al. A simple risk score in acute ST-elevation myocardial infarction:modified ACEF(age, creatinine, and ejection fraction)score[J]. Turk J Med Sci,2016,46(6):1688-1693.