Comparison Of The Prognostic Predictive Value Of Three Prognostic Scores In Nonvalvular Atrial Fibrillation Patients With NSTE-ACS Undergoing PCI With Coronary Stent

Objective:1.To investigate and analysis the clinical features,adverse events and factors related to adverse events of the 1510 cases of NSTE-ACS patients with NVAF Undergoing PCI with Coronary Stent.2.To investigate and compare the predictive ability of the adverse events between the GRACE score,the CHADS₂ score and the CHA₂DS₂-VASc score to the NSTE-ACS patients with NVAF Undergoing PCI with Coronary Stent.PART ONEComparison of the Prognostic Predictive Value of the MACCEs between the three Prognostic Scores in NSTE-ACS patients with NVAF Undergoing PCI with Coronary StentMethods:Randomized retrospective investigate and analysis and random sampling method to select tertiary hospitals in Beijing area from Jan.1,2010 to Dec.31,2014.There were 1585 patients subjected with the diagnosis of NSTE-ACS patients with NVAF Undergoing PCI enrolled in our study.The GRACE,CHADS₂,and CHA₂DS₂-VASc scores were obtained based on the baseline data of each patient.According to the follow-up of patients with or without MACCEs events,NSTE-ACS patients with NVAF Undergoing PCI were divided into MACCEs group and non-MACCEs group to analyze the risk factors of MACCEs events.The endpoint was MACCEs event and patients were followed up by telephone or in clinic.Using Cox proportional hazard regression to make univariate and multivariate analysis and drawing the ROC curve of the GRACE,CHADS₂,and CHA₂DS₂-VASc scores to compare their ability to predict MACCEs.Using Delong test to compare the area under ROC curve.Result:1.Characteristics of clinical data:A total of 1510 NSTE-ACS patients with NVAF Undergoing PCI were followed up,the mean follow-up time was 39.1±18 months.The average age was 67.13±9.5.High blood pressure and heart failure are the most common diseases in complication.A total of 268 patients had MACCEs events accounted for 1510 of the patients in the 17.75%.Age（HR=1.051,95%CI:1.022-1.081,P=0.001）,GRACE（HR=1.005,95%CI:1.002-1.008,P=0.01）,and oral anticoagulants（HR=1.678,95%CI:1.147-2.457,P=0.008）were the independent risk factors for MACCEs.eGFR 4R=0.990,95%CI:0.984-0.995,P=0.01)and LVEF（HR=0.985,95%CI:0.975-0.996,P-0.006）are a protective factor for MACCEs.2.Cox proportional hazards regression and ROC curve analysis showed that the GRACE score had predictive value for the occurrence of MACCEs after PCI in patients with NSTE-ACS and NVAF[AUC=0.632,95%CI:0.610-0.654,P=0.024].Conclusion:1.Multivariate analysis showed that age,LVEF,eGFR,and oral anticoagulation were associated with MACCEs events in patients with NSTE-ACS and NVAF after PCI.2.GRACE score can predict the occurrence of MACCEs events in NSTE-ACS patients with NVAF after PCI.PART TWOThe Value of CHADS₂ score and CHA₂DS₂-VASc score in Predicting Ischemic Stroke in Nonvalvular Atrial Fibrillation Patients with NSTE-ACS Undergoing PCI with Coronary StentMethods:1.Randomized retrospective investigate and analysis and random sampling method to select tertiary hospitals in Beijing area from Jan.1,2010 to Dec.31,2015.There were 1585 patients subjected with the diagnosis of NSTE-ACS patients with NVAF Undergoing PCI enrolled in our study.The CHADS₂,and CHA₂DS₂-VASc scores were obtained based on the baseline data of each patient.According to the follow-up of patients with ischemic stroke events,the NSTE-ACS patients with NVAF undergoing PCI with coronary stent were divided into two groups:the ischemic stroke group and the non-ischemic stroke group in order to analysis the risk factors of ischemic stroke.According to the patients’ antithrombotic treatment scheme,the patients were divided into the anti-platelet drugs + oral anticoagulation group,two kinds of anti-platelet drugs + oral anticoagulation group and two kinds of anti-platelet drugs group in order to compare of the prognosis of patients taking different and the comparison of different antithrombotic therapy the prognosis of patients taking different antithrombotic drugs.2.The endpoint was ischemic stroke event and patients were followed up by telephone or in clinic.Using Cox proportional hazard regression to make univariate and multivariate analysis and drawing the ROC curve of the CHADS₂,and CHA₂DS₂-VASc scores to compare their ability to predict ischemic stroke event.Using Delong test to compare the area under ROC curve.Patients with CHADS₂ score of 1 and 0 score were rescored by using CHA₂DS₂-VASc score in order to analysis the incidence of ischemic stroke after rescoring.Comparative analysis the patients whose CHADS₂ score or CHA₂DS₂-VASc score>2 in order find the incidence of ischemic stroke in high-risk patients.Result:1.Comparison of ischemic stroke events and major bleeding events in patients treated with the anti-platelet drugs + oral anticoagulation group,two kinds of anti-platelet drugs + oral anticoagulation group（P>0.05）;The incidence of small bleeding events in the two groups was higher than that in two kinds of anti-platelet drugs group（P<0.05）.The incidence of small bleeding events compared with the anti-platelet drugs +oral anticoagulation group,two kinds of anti-platelet drugs + oral anticoagulation group（P>0.05）.2.Multivariate analysis with the Cox regression models showed that CHADS₂ score（HR=1.463,95%CI:1.262-1.695,P=0.002）and CHA₂DS₂-VASc score（HR=1.300,95%CI:1.162-1.455,P=0.001）.The ROC analysis showed that CHADS₂ score（AUC=0.671,95%CI:0.65-0.693,P=0.019）CHA₂DS₂-VASc score（AUC=0.674,95%CI:0.653-0.696,P=0.0023）.Comparison of CHADS₂ score and CHA₂DS₂-VASc score under ROC curve area through the DeLong test（P=0.829）.3.Comparative analysis the patients whose CHADS₂ score or CHA₂DS₂-VASc score>2 points.A total of 958 people whose CHADS₂ score>2 points,of which 52 cases had ischemic stroke and 80 patients taking oral anticoagulants after discharge.A total of 1275 people whose CHA₂DS₂-VASc score>2 points,of which 80 cases had ischemic stroke and 101 patients taking oral anticoagulants after discharge.Conclusion:1.There was no significant difference in the incidence of ischemic stroke and major bleeding events between the two groups:the anti-platelet drugs + oral anticoagulation group and the two kinds of anti-platelet drugs + oral anticoagulation group.The incidences of small bleeding events were higher in the two groups of oral anticoagulant groups than the two kinds of anti-platelet drugs group.There was no significant difference between the two oral anticoagulant groups.2.The CHADS₂ score and CHA₂DS₂-VASc score were the best scoring system for evaluating ischemic stroke of the NSTE-ACS patients with NVAF undergoing PCI.CHADS₂ score has less items than CHA₂DS₂-VASc score,and is more suitable for the primary hospitals.And CHA₂DS₂-VASc score can find the patients with low risk of ischemic stroke.3.According to the latest domestic and international guidelines,probability of anticoagulation therapy in patients enrolled in this study is low and not strictly.