2018 年第 11 期 第 13 卷

急性心肌梗死患者中ACEF评分预测院内死亡的价值

Predictive value of ACEF score for in-hospital mortality in patients with acute myocardial infarction

作者：魏小红刘文娴陈立颖曹佳宁

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科重症监护室

英文单位：

关键词：急性心肌梗死；院内死亡；ACEF评分

英文关键词：

• 摘要：

• 【摘要】目的    评价ACEF评分对急性心肌梗死患者院内死亡风险的预测价值。方法    回顾性分析首都医科大学附属北京安贞医院2009年1月至2015年12月收治的完成急诊冠状动脉介入治疗的1 061例急性心肌梗死患者的临床资料。运用受试者工作特征（ROC）曲线分析ACEF评分对急性心肌梗死患者院内死亡的预测价值，并选取最佳界值，利用最佳界值将患者分为2组，对2组患者的临床特征进行统计学比较。结果    ACEF评分预测急性心肌梗死院内死亡的ROC曲线下面积为0.714，最佳界值为1.23。将患者分为A组（ACEF评分≤1.23分）及B组（ACEF评分>1.23分），2组患者临床特征比较发现，B组患者Killip心功能分级Ⅲ～Ⅳ级的比例高于A组，收缩压、舒张压、血红蛋白、空腹血糖、左心室射血分数低于A组，差异均有统计学意义（均P<0.05）。B组患者前壁心肌梗死的比例高于A组,双支及多支病变的比例高于A组，Gensini积分明显高于A组，且经皮冠状动脉介入治疗术后梗死血管心肌梗死溶栓试验血流3级的比例低于A组，差异均有统计学意义（均P<0.05）。B组心源性休克、急性左心衰竭、心律失常及心脏破裂4类急性心肌梗死并发症的发生率均高于A组，主动脉内球囊反搏使用率明显高于A组［18.9%（69/365）比5.3%（37/696）、17.3%（63/365）比5.3%（37/696）、34.2%（122/365）比17.1%（117/696）、2.0%（7/365）比0.2%（1/696）、41.9%（153/365）比20.0%（139/696）］，差异均有统计学意义（均P<0.05）。B组院内病死率明显高于A组［10.4%（38/365）比2.8%（18/696）］，差异有统计学意义（P<0.05）。结论    ACEF评分对急性心肌梗死患者危重程度具有良好的辨识力，ACEF评分是预测急性心肌梗死患者院内死亡风险的简单、有效的方法。

• 【Abstract】Objective    To evaluate the predictive value of ACEF score for in-hospital mortality in patients with acute myocardial infarction. Methods    Clinical data of 1 061 patients with acute myocardial infarction who had emergency coronary intervention in Beijing Anzhen Hospital, Capital Medical University from January 2009 to December 2015 were retrospectively analyzed. The value of ACEF score in prediction of in-hospital mortality was analyzed by receiver operating characteristic（ROC） curve. Clinical features of patients with different ACEF score were analyzed. Results    Area of ROC curve of ACEF score in prediction of in-hospital mortality was 0.714; the critical value was 1.23. The patients were divided into group A(ACEF score≤1.23) and group B(ACEF score>1.23). Proportion of Killip cardiac function grade Ⅲ-Ⅳ in group B was higher than that in group A; systolic pressure, diastolic pressure, hemoglobin, fasting blood glucose and left ventricular ejection fraction in group B were lower than those in group A(P<0.05). Proportions of anterior wall myocardial infarction, double vessel lesions, multi-vessel lesions and Gensini score in group B were higher than those in group A; proportion of thrombolysis in myocardial infarction grade 3 after coronary intervention in group B was lower than that in group A（P<0.05）. Incidences of cardiac shock, acute left heart failure, arrhythmia, heart rupture and the use rate of intra-aortic balloon counterpulsation in group B were higher than those in group A［18.9%（69/365） vs 5.3%（37/696）, 17.3%（63/365） vs 5.3%（37/696）, 34.2%（122/365） vs 17.1%（117/696）, 2.0%（7/365） vs 0.2%（1/696）, 41.9%（153/365） vs 20.0%（139/696）］(P<0.05). In-hospital mortality rate in group B was higher than that in group A［10.4%(38/365) vs 2.8%(18/696)］(P<0.05). Conclusion    ACEF score has a good predictive value for the severity and in-hospital mortality of patients with acute myocardial infarction.