摘要目的 在HEART评分系统基础上,研究HEARTS3评分对提高急诊非ST段抬高胸痛患者危险分层和急性冠脉综合征(ACS)的预测应用价值.方法 回顾性分析2011年7月至2015年5月775例符合标准的急诊非ST段抬高胸痛患者,分别进行HEART和HEARTS3评分,并随访患者发病后30 d内ACS和心肌梗死(MI)发病情况,根据评分进行危险分层,分析不同分层患者发病后30 dACS与MI的发生情况与评分之间的关系,并比较两种评分对胸痛患者发病后30 d ACS的预测能力.使用SPSS 13.0软件进行统计分析计数资料以百分比(％)表示,两组计量资料之间的比较用成组t检验,两种评分不同评分段患者发生ACS比例比较用行x列表x2检验,每种评分方法对发生心血管事件ACS患者分辨度用ROC曲线下面积(AUROC),并用Z检验进行比较.结果 共有92例发病后30 d发生ACS,HEART和HEARTS3的对高危胸痛患者预测敏感性分别为64.79％、77.97％,特异性分别为97.57％、97.85％.HEART与HEARTS3危险评分ROC曲线下面积,MI(0.952 vs.0.813;P =0.028),30 dACS (0.913 vs.0.815;P=0.034),两者差异具有统计学意义.结论 HEART和HEARTS3都可以应用于急诊胸痛患者的危险分层和预后评估,但HEARTS3更可靠.

abstractsObjective To investigate the value of detecting HEART score and HEARTS3 score in risk stratification and prognosis of acute coronary syndrome (ACS) in patients with non-ST segment elevation chest pain in emergency department (ED).Methods Clinical data of case-control retrospective study of 775 patients with non-ST segment elevation chest pain in ED were collected from July 2011 to March 2015.The patients were estimated and risk stratification was made with HEART score and HEARTS3 score.After follow-up visiting by telephone for 30 days,outcomes were found to be ACS and myocardial infarction (MI).And the patients were categorized with score into low,intermediate and high risk groups.The correlation between the ACS and risk score in three groups was analyzed.Comparison of capability of performance in predicting 30-day ACS between the HEART score and HEARTS3 risk score.Statistical analyses were performed using SPSS13.0.Enumeration variables were expressed as percentage.For comparison of predictive value of the two sets of scores,area under the receiver operating curve (auROC) was calculated and compared by Z test.Results There were 92 cases with 30-day ACS.The rate of ACS had a trend of increase with increase in HEART score and HEARTS3 score.The patients with higher scores of HEART and HEARTS3,higher incidence of ACS in 30 days.Especially,the high-risk patients with score≥7 of HEART score and≥8 of HEARTS3 score had higher rate of ACS.And there was significant difference in predicting high-risk patients between two sets of scoring (P ＜ 0.05).The HEARTS3 score outperformed the HEART score as determined by comparison of areas under the ROC curve for MI (0.952 vs 0.813;P =0.028),30-day ACS (0.913 vs.0.815;P =0.034).Conclusions HEART score and HEARTS3 score both can be used to evaluate and perform risk stratification for non-ST segment elevation chest pain patients in ED.But HEARTS3 score can more precisely stratify high-risk patients with chest pain for 30-day ACS.