张帅勇,李梦瑶,雷雨萌,陈明,闫微,吕峰峰,曹绪芬,颜利求

• 1:河北医科大学附属沧州市中心医院心血管内科

摘要(Abstract)：

目的 评价全球急性冠状动脉事件注册研究（GRACE）出院评分对急性冠状动脉综合征（ACS）合并慢性肾功能不全（CRI）患者经皮冠状动脉介入治疗（PCI）术后远期死亡的预测价值。方法 回顾性入选2014年1月至2017年9月于河北医科大学附属沧州市中心医院接受PCI术的ACS合并CRI患者1 308例，根据GRACE出院评分分为低危组（527例）、中危组（575例）和高危组（206例）。对所有患者记录全因死亡及心原性死亡的发生情况。通过时间依赖的受试者工作特征（ROC）曲线下面积（AUC）与Greenwood-Nam-D’Agostino(GND)拟合优度检验评估GRACE出院评分对ACS合并CRI患者PCI术后远期全因死亡及心原性死亡的预测价值。结果 中位随访38个月内发生全因死亡及心原性死亡患者分别为50例（3.8%）和32例（2.4%）。低危组、中危组及高危组之间累积全因死亡率的差异有统计学意义（2.6%比7.1%比7.4%,P=0.033），而三组之间累积心原性死亡率差异无统计学意义（P=0.523）。Cox回归分析结果显示：高危组全因死亡风险是低危组的2.69倍（95%CI 1.21～5.99,P=0.015），中危组全因死亡风险是低危组的2.04倍（95%CI1.03～4.04,P=0.040）。随访6、12、24、36及48个月全因死亡AUC分别为0.675、0.629、0.601、0.632和0.642，心原性死亡AUC分别为0.744、0.668、0.564、0.614和0.615。GND拟合优度检验显示GRACE出院评分模型对于全因死亡及心原性死亡结局预测校准度良好（P=0.720,P=0.287）。结论 GRACE出院评分对于ACS合并CRI患者PCI术后远期全因死亡及心原性死亡具有一定预测价值，且可以较好地区分出发生全因死亡的中高危与低危患者。

关键词(KeyWords)： GRACE出院评分;急性冠状动脉综合征;慢性肾功能不全;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 河北省自然科学基金项目（H2021110008）;; 河北省重点研发计划自筹项目（172777163）

作者(Author): 张帅勇,李梦瑶,雷雨萌,陈明,闫微,吕峰峰,曹绪芬,颜利求

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