EuroSCOREⅡ评分及Gensini评分与冠心病PCI术后主要不良心血管事件发生的相关性研究

Study on the correlation between EuroSCORE Ⅱ score, Gensini score and the occurrence of major adverse cardiovascular events in patients with coronary heart disease after PCI

摘要:

目的]探究新版欧洲心脏手术风险评分系统(EuroSCOREⅡ)评分及Gensini评分与冠心病(CHD)患者经皮冠状动脉介入治疗(PCI)后主要不良心血管事件(MACE)发生的相关性。 [方法]选择空军军医大学第一附属医院心血管外科2021年1月—2023年3月收治的203例行PCI术的CHD患者作为研究对象。根据是否发生MACE分为MACE组和非MACE组。对比两组患者临床资料；利用Pearson相关系数分析EuroSCOREⅡ评分与Gensini评分的相关性；利用Logistic回归模型评估CHD患者PCI术后出现MACE的危险因素；绘制ROC曲线分析预测指标对CHD患者PCI术后出现MACE的预测价值。 [结果]术后随访1年期间,203例行PCI术的CHD患者中共有65例出现MACE(32.02%)。MACE组年龄、糖尿病史占比、Killip分级≥Ⅱ级占比、病变血管数量≥2个占比、支架数量≥2个占比、EuroSCOREⅡ评分及Gensini评分均高于非MACE组,差异均有统计学意义(P＜0.05)。经Pearson相关系数分析显示,EuroSCOREⅡ评分与Gensini评分呈正相关(r＝0.200,P＝0.004)。Logistic回归模型分析显示,年龄增加、Killip分级≥Ⅱ级、高EuroSCOREⅡ评分及高Gensini评分是CHD患者PCI术后出现MACE的独立危险因素(P＜0.05)。ROC曲线分析显示,年龄增加、Killip分级≥Ⅱ级、EuroSCOREⅡ评分、Gensini评分及联合预测对于判断PCI术后出现MACE均具有统计学意义(P＜0.05)；其中联合预测的AUC为0.953,95%CI为0.928~0.979,灵敏度为0.892,特异度为0.891,预测价值较高。 [结论]年龄增加、Killip分级≥Ⅱ级、高EuroSCOREⅡ评分及高Gensini评分是CHD患者PCI术后出现MACE的独立危险因素,均对CHD患者PCI术后出现MACE具有一定的预测价值,且联合预测价值更高。

Abstract:

Aim To investigate the correlation between the new version of the European System for Cardiac Operative Risk Evaluation Ⅱ (EuroSCORE Ⅱ) score, Gensini score and the occurrence of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Methods A total of 203 CHD patients undergoing PCI treatment admitted to the Department of Cardiovascular Surgery of the First Affiliated Hospital of Air Force Military Medical University from January 2021 to March 2023 were selected as the study objects. Depending on whether MACE happened or not, they were divided into MACE group and non-MACE group.The clinical data of the two groups of patients was compared. Pearson's correlation coefficient was used to analyze the correlation between EuroSCORE Ⅱ score and Gensini score; Logistic regression model was used to evaluate the risk factors for the development of MACE after PCI in patients with CHD; and ROC curves was used to analyze the predictive value of predictive indexes for the development of MACE after PCI in patients with CHD. Results In 203 cases of CHD patients who underwent PCI, 65 of them experienced MACE during the 1-year postoperative follow-up (32.02%). The age, rate of history of diabetes mellitus, rate of Killip classification ≥ gradeⅡ, rate of ≥ 2 diseased vessels, rate of ≥ 2 stents, EuroSCOREⅡscore, and Gensini score of the MACE group were higher than those of the non-MACE group, and the differences were all statistically significant (P＜0.05). The results of the Pearson's correlation analysis indicated that there was a positive correlation between the EuroSCOREⅡscore and Gensini score (r＝0.200, P＝0.004). Logistic regression model analysis showed that age increase, Killip classification ≥ gradeⅡ, high EuroSCOREⅡscore, and high Gensini score were independent risk factors for the development of MACE after PCI in CHD patients (P＜0.05). ROC curve analysis showed that age increase, Killip classification ≥ gradeⅡ, EuroSCOREⅡscore, Gensini score, and combined prediction had statistical significance in determining the occurrence of MACE after PCI (P＜0.05); The area under the curve (AUC) of combined prediction was 0.3,5%CI was 0.928~0.979, sensitivity was 0.892, specificity was 0.891, indicating high predictive value. Conclusion Age increase, Killip classification≥gradeⅡ, high EuroSCOREⅡscore, and high Gensini score are independent risk factors for the occurrence of MACE after PCI in patients with CHD, and all of them have a certain predictive value for MACE after PCI in patients with CHD, and the combined predictive value is higher.