改良HEART评分与GRACE评分在急诊高危胸痛患者分层治疗中的对比评价

唐开放; 孔健华; 冯玉丽; 刘贝珠; 韩明

doi:10.13201/j.issn.1009-5918.2020.04.013

改良HEART评分与GRACE评分在急诊高危胸痛患者分层治疗中的对比评价

- 广州市番禺区何贤纪念医院急诊科(广州, 511400)
基金项目:
广州市番禺区科技计划项目(No:2018-Z04-28)

详细信息

通讯作者: 韩明,E-mail:13392131135@163.com

中图分类号: R459.7

收稿日期: 2019-08-16

Comparison of modified HEART score and GRACE score in stratified treatment of high-risk chest pain in emergency department

- Department of Emergency, Hexian Memorial Hospital of Panyu District, Guangzhou, 511400, China

More Information

Corresponding author: HAN Ming, E-mail: 13392131135@163.com

Received Date: 16 August 2019

摘要

摘要: 目的:对比评价改良HEART评分和GRACE评分在急诊高危胸痛患者分层治疗中的临床价值。方法:以2018-01—2019-03期间收治的以胸痛为主诉的1 901例急诊胸痛患者为研究对象,分别使用改良HEART评分和GRACE评分对入选患者进行危险分层,依据评分高低进行处理和治疗,并对患者出院后3个月的治疗效果及预后情况进行回访,通过对照分析,评价两种方法的临床价值。结果:改良HEART评分和GRACE评分分层治疗预测高危胸痛(ACS、主动脉夹层、肺动脉栓塞)患者的准确率分别为82.7%、100.0%、100.0%和50.6%、22.2%、25.0%,改良HEART评分的准确率显著高于GRACE评分,差异有统计学意义(P<0.01)。改良HEART评分和GRACE评分分层治疗预测ACS亚组高危组(STEMI、NSTEMI、UA)的准确率分别为94.2%、88.2%、50.0%和46.5%、64.8%、47.2%,其中STEMI组及NSTEMI组改良HEART评分准确率显著高于GRACE评分,差异有统计学意义(P<0.01),而UA组差异无统计学意义(P>0.05)。改良HEART评分ROC曲线下面积分别为0.792、0.831、0.852;GRACE评分ROC曲线下面积分别为0.698、0.706、0.715,改良HEART评分预测急性高危胸痛患者心血管事件的灵敏度、特异度均显著高于GRACE评分(P<0.05)。结论:改良HEART评分能快速、准确地对急诊高危胸痛患者进行预检分诊、危险分层并处理,对急诊高危胸痛患者预后评估具有重要的临床价值。
- 改良HEART评分 /
- GRACE评分 /
- 急诊胸痛 /
- 分层治疗 /
- 对比评价
Abstract: Objective: To compare and evaluate the clinical value of modified HEART score and GRACE score in stratified treatment of emergency high-risk chest pain patients. Method: In this study, 1 901 emergency patients with chest pain complained mainly from January 2018 to March 2019 were selected as subjects. The risk stratification of selected patients was carried out by using improved HEART score and GRACE score, and the treatment were carried out according to the score level. The therapeutic effect and prognosis of the patients were also visited three months after discharge. The clinical value of the two methods was evaluated through comparative analysis. Result: The accuracy of modified HEART score and GRACE score in predicting high-risk chest pain(ACS, aortic dissection and pulmonary embolism) was 82.7%, 100.0%, 100.0% and 50.6%, 22.2% and 25.0%, respectively. The accuracy of modified HEART score was significantly higher than that of GRACE score, with significant statistical significance(P<0.01). The accuracy of modified HEART score and GRACE score in predicting high-risk group of ACS subgroup(STEMI, NSTEMI, UA) was 94.2%, 88.2%, 50.0% and 46.5%, 64.8% and 47.2%, respectively. The accuracy of modified HEART score in STEMI group and NSTEMI group was significantly higher than that in GRACE score, with significant statistical significance(P<0.01), but the UA group was higher than 0.05, there was no statistical significance. The area under the ROC curve of the modified HEART score was 0 792, 0.831 and 0.852, and the area under the ROC curve of the GRACE score was 0.698, 0.706 and 0.715, respectively. The sensitivity and specificity of the modified HEART score in predicting cardiovascular events in patients with acute high-risk chest pain were significantly higher than those of the GRACE score(P<0.05).Conclusion: Modified HEART score can quickly and accurately diagnose and classify the patients with high-risk chest pain in emergency department. It has important clinical value in evaluating the prognosis of patients with high-risk chest pain in emergency department.
- modified HEART score /
- GRACE score /
- emergency chest pain /
- stratified therapy /
- contrastive evaluation

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