| Purpose: By analyzing the predictive values of ischemic stroke through SYNTAX score,GRACE score,TIMI risk score system compared with CHADS2 score,CHA2DS2-VASC score system by condition of sinus rhythm of patients with coronary heart disease(CHD),the paper is to provide a new tool to predict ischemic stroke for patients with CHD.Method: We collected 260 cases of patients(experimental group)with chest pain as the chief complaint and being diagnosed with coronary angiography as CHD at Dandong Central Hospital from January,2013 to December,2014.Meanwhile,we selected 260 cases of hospitalized patients(control group)with normal coronary angiography results although having chest pain at the same period.Then,we have followed up the selected 520 cases of hospitalized patients for 1 year by the end of 2015 and by the end of the event of whether the patients suffered from ischemic stroke(ischemic stroke diagnostic criteria in line with cerebrovascular disease diagnosis standard formulated at the fourth national cerebrovascular disease conference in 1995)approved by head CT or MRI).According to the results of follow-up of 520 patients,the patients were divided into ischemic stroke group and non ischemic stroke group.All patients were in sinus rhythm and being performed coronary angiography examination after admission.The positive standard of coronary angiography is that the diameter stenosis of at least one main branches of coronary artery is up to 50% or higher.After all patients were admitted to hospital,we calculated SYNTAX score,GRACE score,TIMI 4 integral,CHADS2 score and CHA2DS2-VASC score by using T test,X~2 test,spearman analysis and ROC curves and got predictive values of ischemic stroke by condition of sinus rhythm of patients with CHD through comparing three CHD score systems with two atrial fibrillation score systems.Results:(1)The SYNTAX score,GRACE score,TIMI risk score,the CHADS2 score and CHA2DS2-VASC score of CHD patients in experimental group(27.9±1.5、129.26±19.02、4.56±1.50、2.3±0.6、2.4±0.5)are significantly higher than those of Non-CHD patients in control group(0.23±0.9、106.91±20.77、1.15±0.42、0.5±0.2、0.6±0.4),with the statistically difference(P<0.05);(2)There are 54 patients with ischemic stroke in 520 patients,including 50 patients in experimental group(19.2%)and4 patients in control group(1.54%,P < 0.05).SYNTAX score,GRACE score,TIMI risk score,CHADS2 score and CHA2DS2-VASC score of patients with ischemic stroke(33.5±2.5、133.8±16.8、4.78±1.94、2.84±1.3、2.9±1.5)are significantly higher than those of patients with stroke group(9.3±0.6、109.4±21.41、1.20±0.56、0.8±0.5、0.9±0.4),with the statistically difference(P<0.05);(3)The SYNTAX score,GRACE score,TIMI risk score,CHADS2 score and CHA2DS2-VASC score of 260 patients with CHD(experimental group)were significantly and positively correlated(R2=0.508、0.402、0.406、0.516、0.423、0.418);(4)ROC curve shows predictive values of ischemic stroke by five risk points systems: CHA2DS2-VASC score > CHADS2 score > GRACE SYNTAX score > TIMI risk score.The AUC value of CHA2DS2-VASC score,SYNTAX score GRACE score,TIMI scores and CHADS2 score is respectively 0.891,0.752,0.627,0.617 and0.774.The sensitivity and specificity of SYNTAX score is respectively 64.7% and78.4%,the sensitivity and specificity of GRACE score is respectively 59.1% and 74.1%,the sensitivity and specificity of TIMI score is respectively 51.6% and 72.2%,the sensitivity and specificity of CHADS2 score is respectively 70.1%,and 84.2%,the sensitivity and specificity of CHA2DS2-VASC score is respectively75.3% and 89.9%.Conclusion: In accordance with CHADS2 score and CHA2DS2-VASC score,the risk scoring system of SYNTAX,GRACE and TIMI for CHD,can not only predict cardiac events for patients with CHD,but also evaluate the risk of ischemic stroke.The predictive value is : CHA2DS2-VASC score > CHADS2 score > SYNTAX score > GRACE score >TIMI risk score. |
