GRACE评分联合sdLDL-C对PACS合并多支病变患者发生MACE的预测价值

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【Abstract】ObjectiveToexplorethe predictiveefcacyofthe Global Registryof Acute Coronary Events（GRACE）scorecombined withsmalldnselowdnsitylipoproteinholestero（sLDL-C）forajoradversecardovascularevents（MACE）inpatintswithpreature acutecoronarysyndrome（PACS）andmultiveseldisease（MVD）.MethodsAretrospectiveanalysiswasperformedon847patients diagnosedwithPACSandMVDatTheFirstAfiliatedHospitalofXinjiangMedicalUniverstyfromMay2O22toNovember2O23.Temedian folow-upwas12months（9months，5months）andpatientswerecategorizedintoMACEandon-MACEgroupsbasedonfollo-up outcomes，andclicaldatarecomparedbetweenthewogroups.MultivariateCoxegresionanalysisasusedtoidentifyidepedent predictivefactorsofACE.TeROCurves，teetclasificationidex（N）andtheintegateddiscminationdex（D）wreuedto assess the predictivepowerofGRACEscorecombinedwithsdLDL-CforMACE.ResultsDuringthefolow-upperiod，24cases（ 14.64% ） of MACEocurred.Both GRACEscore andsdLDL-Clevels were significantly higherinthe MACE groupcomparedtothe non-MACE group （ P<0.001 ）. Multivariate Cox regression analysis revealed that GRACE score（ HR=1 . 014， 95% CI 1.008～1. 026）and sdLDL-C（ HR= 1.015，95% CI 1.003～1.114）were all independent predictors of MACE in patients with PACS and MVD（ P<0. 05 ）. The ROC curve analysisdemonstratedtatbothGRACEscoreandsdLDL-ChadpredictivevalueforMACE，andtheircombinedusesignificantlyimproved diagnostic performance（AUC：GRACE score alone O.693，combined with sdLDL-C 0.711， P<0. 001 ）.Incorporating sdLDL-C into the GRACE score model significantly improved NRI and IDI（NRI=0.221， P=0.023 IDI=0.011 P=0.004 ）.Conclusion The combination ofGRACEscoreandsdDL-CprovidessuperiorpredictivevaluforMACEinPACSpatientswithMVDoferingavuableeferfs stratification and prognosis assessment in high-risk populations.

【KeyWords】GlobalRegstrof cuteCoronaryEventsscore;Smalldenselow-densitylipoproteincholesterol;Prematureacuteoronar syndrome;Multivessel disease; Prognosis

急性冠脉综合征（acute coronary syndrome，ACS）是心血管疾病（cardiovasculardisease，CVD）中最危重的临床类型，其病理机制主要是冠状动脉粥样硬化斑块破裂或糜烂进而引发完全或不完全性血栓形成[]ACS具有较高的发病率和病死率，且近年来发病群体呈现年轻化趋势[2]。（剩余12474字）