李瑞瑞,王馨培,崔世炜,边田华,骆雅丽,刘晓晨

• 1:沧州市人民医院心内科

摘要(Abstract)：

目的:评估GRACE评分与ACEF评分对2型心肌梗死(T2MI)患者3年主要不良心血管事件(MACE)的预测价值，并构建联合预测模型。方法:连续纳入2019年1月—2021年12月于沧州市人民医院心内科住院的T2MI患者510例。计算入院GRACE评分和ACEF评分。主要终点为3年MACE(全因死亡、非致死性心肌梗死、血运重建、非致死性脑卒中、因不稳定心绞痛或心力衰竭再住院的复合终点)。采用Cox回归分析影响因子，通过ROC曲线分析评分的预测价值。结果:中位随访36个月，106例(20.8%)发生MACE。多因素Cox回归显示，GRACE评分(HR=1.625,95%CI:1.308～2.018)和ACEF评分(HR=2.142,95%CI:1.809～2.537)均是MACE的独立预测因子(均P<0.01)。联合模型的AUC为0.780(95%CI:0.741～0.815),显著高于GRACE评分(0.714,P=0.002)和ACEF评分(0.751,P=0.038)。结论:GRACE评分和ACEF评分均是T2MI患者远期预后的独立预测因子，二者联合可显著提升预测效能。

关键词(KeyWords)： 2型心肌梗死;GRACE评分;ACEF评分;预后;主要不良心血管事件

Abstract:

Keywords:

基金项目(Foundation): 2027年度河北省医学科学研究课题计划项目（No:20270614）

作者(Author): 李瑞瑞,王馨培,崔世炜,边田华,骆雅丽,刘晓晨

DOI: 10.13201/j.issn.1001-1439.2026.10.011

参考文献(References)：

• [1]Thygesen K,Alpert JS,Jaffe AS,et al.Fourth universal definition of myocardial infarction(2018)[J].J Am Coll Cardiol,2018,72(18):2231-2264．
• [2]Chapman AR,Adamson PD,Shah ASV,et al.Highsensitivity cardiac troponin and the universal definition of myocardial infarction[J].Circulation,2020,141(3):161-171．
• [3]McCarthy CP,Vaduganathan M,Januzzi JL Jr.Type 2myocardial infarction:diagnosis,prognosis,and treatment[J].JAMA,2018,320(5):475-476．
• [4]Chapman AR,Shah ASV,Lee KK,et al.Long-term outcomes in patients with type 2myocardial infarction and myocardial injury[J].Circulation,2018,137(12):1236-1245．
• [5]Fox KA,Fitzgerald G,Puymirat E,et al.Should patients with acute coronary disease be stratified for management according to their risk Derivation,external validation and outcomes using the updated GRACE risk score[J].BMJ Open,2014,4 (2):e004425．
• [6]Ranucci M,Castelvecchio S,Menicanti L,et al.Risk of assessing mortality risk in elective cardiac operations:age,creatinine,ejection fraction,and the law of parsimony[J].Circulation,2009,119(24):3053-3061．
• [7]Wykrzykowska JJ,Garg S,Onuma Y,et al.Value of age,creatinine,and ejection fraction(ACEF score)in assessing risk in patients undergoing percutaneous coronary interventions in the'All-Comers'LEADERStrial[J].Circ Cardiovasc Interv,2011,4(1):47-56．
• [8]St??hli BE,Wischnewsky MB,Jakob P,et al.Predictive value of the age,creatinine,and ejection fraction(ACEF)score in patients with acute coronary syndromes[J].Int J Cardiol,2018,270:7-13．
• [9]宋岳涵，张小琼，孙雪，等．胸痛中心模式下急性ST段抬高型心肌梗死患者预后的预测模型构建与验证[J]．临床心血管病杂志，2025(1):67-73．
• [10]Chapman AR,Hesse K,Andrews J,et al.High-sensitivity cardiac troponin I and clinical risk scores in patients with suspected acute coronary syndrome[J].Circulation,2020,141(14):1107-1117．
• [11]Wang J,Wang D,Su F,et al.ACEF score as a predictor of cardiovascular events:A large prospective cohort study in Northeast China[J].Front Cardiovasc Med,2021,8:734678．
• [12]Kristic I,Crncevic N,Lovric D,et al.Comparison of six different risk scores in patients with non-ST elevation myocardial infarction[J].Acta Clin Croat,2020,59(3):435-442．
• [13]Gao S,Ma W,Huang S,et al.Predictive value of ACEF score for long-term prognosis in patients with myocardial infarction with non-obstructive coronary arteries[J].Front Cardiovasc Med,2022,9:845632．
• [14]Capodanno D,Marcantoni C,Ministeri M,et al.Incorporating glomerular filtration rate or creatinine clearance by the modification of diet in renal disease equation or the Cockcroft-Gault equations to improve the global accuracy of the age,creatinine,ejection fraction score[J].J Am Coll Cardiol Intv,2013,6(3):307-308．
• [15]Cediel G,Sandoval Y,Sexter A,et al.Risk estimation in type 2myocardial infarction and myocardial injury:The TARRACO score[J].J Am Coll Cardiol,2020,75(18):2256-2267．
• [16]Taggart C,Chapman AR,Halliday P,et al.Derivation and external validation of the type 2 myocardial infarction risk score[J].J Am Coll Cardiol,2023,81(12):1123-1135.