心血管疾病各种评分（Framingham、EuroSCORE、SYNTAX、CRUSADE、TIMI、GRACE、CHA2S2VASc、HAS-BLED等）介绍和具体计算方法（欢迎补充）
其实现在心血管疾病已经成为人类主要杀手，其防治在近年来取得了长足进步；然而，随着人口老龄化，心血管疾病却依然是我们的首要危害疾病。
面对心血管疾病的诊治，其实有很多办法，中国以前大部分靠经验，现在主要靠各种检查。目前，随着国外各种评分的应用，国内也在开展，只是没有引起重视，最近在看各种评分，干脆整理一下。
其实这些评分，都是根据国外很多著名的大型研究演算出来，相信很多研究各位都听说过。
这里主要是介绍来源，具体计算方法很简单，各位只需要到网页或者下载APP即可，结果的解释各大网页和APP都很详细。
Framingham Risk Functions：Risk prediction estimates for the risk of various cardiovascular disease outcomes in different time horizons are available as score sheets and direct risk functions
主要有：（其计算方法可以在线，也可以离线下载，国外很多医生是iPad查房，他们都有这些评分APP，我们国内估计只有靠自己咯）
1 Atrial Fibrillation（Framingham Heart Study AF score (10-year risk) and Calculator）
https://www.framinghamheartstudy.org/risk-functions/atrial-fibrillation/10-year-risk.php#
2 Cardiovascular Disease（Cardiovascular Disease (10-year risk) and Calculator；Cardiovascular Disease (30-year risk) and Calculator – HCVD）
https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php#
3 Congestive Heart Failure
https://www.framinghamheartstudy.org/risk-functions/congestive-heart-failure/index.php
4 Coronary Heart Disease（Hard Coronary Heart Disease (10-year risk) and Calculator；Coronary Heart Disease (10-year risk)；Recurrent Coronary Heart Disease；Coronary Heart Disease (2-year risk) – Second Event）（这个评分在官网有点复杂，但是下面这个链接的计算比较好，直接输入即可）
http://www.mdcalc.com/framingham-coronary-heart-disease-risk-score/
5 Diabetes
https://www.framinghamheartstudy.org/risk-functions/diabetes/index.php#
https://www.framinghamheartstudy.org/risk-functions/hypertension/index.php#
7 Intermittent Claudication
https://www.framinghamheartstudy.org/risk-functions/intermittent-claudication/index.php
8 Stroke（Stroke after Atrial Fibrillation and Calculator；Stroke or Death after Atrial Fibrillation and Calculator）
https://www.framinghamheartstudy.org/risk-functions/stroke/stroke-after-afib.php#
9 根据这个研究，出来了“Framingham Coronary Heart Disease Risk Score”，也就是上面的4，是我们经常应用的一个评分。
http://www.mdcalc.com/framingham-coronary-heart-disease-risk-score/
怎么样？看完上面的，是不是发现FHS研究很强大，而且发现自己知道的是不是有点少？
二、CHADS2评分、CHA2S2VASc评分和HAS-BLED评分（都是近几年AF指南热点，各大指南必不可少的东西）
1 评估房颤患者发生血栓的风险和是否需要应用抗凝药物，目前国内基本CHADS2评分、CHA2S2VASc两个评分都在用。
当然，这个如果记不住，也有软件帮助评分，并给出判断和指导
http://www.mdcalc.com/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk/
2 HAS-BLED评分用于评估房颤患者应用抗凝药物发生出血的风险
这个也同上，记不住也有软件可以提供帮助：
http://www.mdcalc.com/has-bled-score-major-bleeding-risk/
三、TIMI评分
这个是用来评价急性冠脉综合征患者的危险分层评分，来源于 Thrombolysis in Myocardial Infarction (TIMI) Study
http://www.timi.org/index.php?page=about-timi
分为TIMI Risk Score Calculator for UA/NSTEMI和TIMI Risk Score for STEMI两种
1 非ST段抬高急性冠脉综合征患者的危险分层评分（TIMI Risk Score Calculator for UA/NSTEMI）
http://www.timi.org/index.php?page=calculators
2 ST段抬高急性冠脉综合征患者的危险分层评分（TIMI Risk Score Calculator for STEMI）
http://www.mdcalc.com/timi-risk-score-stemi/
四、GRACE（Global Registry of Acute Coronary Events）评分
急性冠脉综合征危险评分，来源于GRACE (the Global Registry of Acute Coronary Events) 研究，GRACE is an international observational programme of outcomes for patients who were hospitalized with an ACS in the 10 years from 1999. GRACE includes nearly 250 hospitals in 30 countries, and enrolled a total of 102,341 patients. Participating physicians receive confidential quarterly reports showing their outcomes side by side with the aggregate outcomes of all participating hospitals. The GRACE Risk Score has been extensively validated prospectively and externally.
GRACE评分分为两种评分，一种是对院内死亡风险的评分，对入院时年龄、心率、血压、血清肌酐水平、心力衰竭的KILLIP分级、入院时是否有心脏停搏、ST段偏离、心肌酶升高水平8项指标来计算积分，各项指标对应相应积分，各项积分相加得到总积分，积分越高，危险越高，院内死亡风险越大。
另一种是对出院后6个月的死亡风险的评估，使用于出院及门诊的ACS患者，对年龄、心率、血压、初始血清肌酐水平、是否有心力衰竭病史、是否有心肌梗死病史、ST段压低、心肌酶升高水平、非院内PCI史9项指标进行积分。
这个评分软件现在已经更新到GRACE 2.0版本，
http://www.gracescore.org/WebSite/WebVersion.aspx
输入各种参数之后，现在GRACE 2.0版本还会给出除了院内和6个月以外，还有1年、3年的发病风险等。
五、CRUSADE评分
NSTEMI急性冠脉综合征患者发生出血风险的评分
CRUSADE评分来源于CRUSADE Quality Improvement Initiative研究：
The CRUSADE Bleeding Score was developed using data from over 89,000 'real-world' patients enrolled in the CRUSADE Quality Improvement Initiative that presented with NSTEMI. We developed (n=71,277) and validated (n=17,857) a logistic regression model to identify eight independent predictors of in-hospital major bleeding. The CRUSADE Bleeding Score was created by assigning a weighted integer to each predictor based on its coefficient in the regression model. A patient's CRUSADE Bleeding Score equals the sum of the weighted scores for the independent predictors (range 1-100 points).
The purpose of CRUSADE is to help clinicians estimate a patient's baseline risk of in-hospital major bleeding during non-ST-segment elevation myocardial infarction (NSTEMI).
http://www.crusadebleedingscore.org/index.html
积分越高，出血风险越大。
积分51-91分，为出血极高危，出血风险为19.5%；
积分41-50分，为出血高危，出血风险为11.9%；
积分31-40出血中危，出血风险为8.6%；
积分21-30分，出血低危危，出血风险为5.5%；
积分11-20分，出血极低危危，出血风险为3.1%；
六、EHRA评分
评价房颤的症状严重性，之前是EHRA 评分，2016年最新指南改为“改良的 EHRA 评分”
七、SYNTAX评分
这个评分也是来源于大型研究SYNTAX Trial,the trial comparing PCI and Cardiac Surgery in complex, high-risk LM and/or 3VD patients. It is important to note that the safety and effectiveness of drug-eluting stents have not been established in these high risk patients, and physicians are strongly encouraged to review the indications, contraindications, warnings and instructions included in the products' Directions for Use.
The SYNTAX Score and related materials are not intended to provide medical advice or guidance as to appropriate treatment strategies for individual patients. Risks and benefits should be carefully considered for each patient taking into account all available data and treatment options and physicians and other healthcare providers should always exercise their own clinical judgment for any given situation. In cases where SYNTAX Score and related materials are relevant to the diagnosis, prevention or treatment of medical conditions which can also be diagnosed, prevented or treated by any products, physicians and other healthcare providers must take care to always follow individual product instructions for use in order to ensure safe use and that the products intended performance(s) is/are achieved. Physicians and other healthcare providers are therefore cautioned that such tools are not intended to supersede individual product instructions for use in any way.
主要用于针对冠状动脉左主干病变和/或三支病变，此评分根据冠状动脉病变解剖特点进行危险分层的积分系统，根据病变位置、严重程度、分叉、钙化等解剖特点定量评价冠脉病变的复杂程度，根据积分的高低为手术方式选择提供初步判断，积分≥33建议行CABG，积分在23-32之间的患者可以选择PCI，也可以选择CABG，积分≤22的患者建议PCI、CABG均可。
目前SYNTAX评分也有两种
http://www.syntaxscore.com/calculator/start.htm
SYNTAX SCORE I：
SYNTAX SCORE II：
因为SYNTAX评分只是单纯的评价冠状动脉病变的情况，为了对患者的评价更加全面及个体化，提出了SYNTAX II评分，SYNTAX II评分是在SYNTAX评分的基础上加上临床变量，性别、年龄、左室射血分数、肌酐清除率、左主干病变、慢性阻塞性肺病、外周血管疾病。
中国经皮冠状动脉介入治疗指南（2016）中指出在血运重建策略选择方面：对合并左主干和/或前降支近段病变、多支血管病变的稳定冠心病患者，应根据SYNTAX评分和SYNTAX II评分评估中远期风险，选择PCI或冠状动脉旁路移植术。
八、EuroSCORE（European System for Cardiac Operative Risk Evaluation）评分{欧洲心血管手术危险因素评分}
Nearly 20 thousand consecutive patients from 128 hospitals in eight European countries were studied. Information was collected on 97 risk factors in all the patients. The outcome (survival or death) was related to the preoperative risk factors. The most important, reliable and objective risk factors were then used to prepare a scoring system. The scoring system was prepared from part of the database and tested and validated on another part. This scoring system is EuroSCORE.
1995年确立的欧洲心血管手术危险因素评分系统，EuroSCOREⅡ在EuroSCORE的基础上进一步完善评分项目，2012年发布，仍是由三方面内容组成。
一、患者本身因素：年龄、性别、肌酐清除率、外周动脉疾病、神经机能障碍、既往心脏手术史、慢性肺脏疾病、活动性心内膜炎、术前危急状态、正在应用胰岛素治疗的糖尿病。
二、心脏相关因素：纽约心脏协会（NYHA）心功能分级、CCS心绞痛分型、左心室功能、近期心肌梗死、肺动脉高压。
三、手术相关因素：紧急外科手术、是否为单纯CABG、胸主动脉手术。得到以上信息后，根据改良的logistic公式，可以计算出EuroSCOREⅡ评分，其具体计算方法繁杂，简单的方法是网上下载专门计算工具，计算得分。（手术低危组积分＜0.9 中危组0.9-1.5 高危组＞1.5）
http://www.euroscore.org/calc.html
九、ADAPT Protocol for Cardiac Event Risk（ADAPT评分）
Assesses chest pain patients at 2-hours for risk of cardiac event.
The ADAPT Score and Accelerated Diagnostic Protocol can be used to evaluate patients with chest pain and potentially identify 20% of patients who are low-risk and can be evaluated with a 0-hour and 2-hour troponin test along with EKG and TIMI Risk Scores (for STEMI and UA/NSTEMI).
Up to 20% of chest pain patients may be able to be safely ruled out for MI and ACS within 2 hours of arrival in the ED, reducing length of stay dramatically without adverse outcome.
http://www.mdcalc.com/adapt-protocol-cardiac-event-risk/
十、Emergency Department Assessment of Chest Pain Score (EDACS)（急诊胸痛EDACS评分）
Identifies chest pain patients with low risk of major adverse cardiac event.
This score only applies to patients:
1 ≥18 years old with normal vital signs
2 Chest pain consistent with ACS
3 No ongoing chest pain or crescendo angina
Patients requiring serial blood testing (serial troponin markers typically at 0 and 6-hours to rule out myocardial infarction) and further risk stratification require an extended emergency department evaluation, leading to crowding and bed allocation problems. The authors of this study were able to find a low-risk group of patients (~45%) that could safely be discharged from the ED after two biomarkers, EKG, and history and physical exam.
十一、HEART Score for Major Cardiac Events（主要心血管事件HEART 评分）
Predicts 6-week risk of major adverse cardiac event
A patient with some nonspecific features of their workup (history, EKG, troponin) can be more objectively risk stratified for their chest pain, quantify his/her risk, and potentially lead to shorter hospital stays, fewer inappropriate interventions and more appropriate interventions.
http://www.mdcalc.com/heart-score-major-cardiac-events/
十二、ASCVD (Atherosclerotic Cardiovascular Disease) 2013 Risk score（动脉粥样硬化心血管风险ASCVD 评分）
Determines 10-year risk of heart disease or stroke.
The ASCVD Risk Estimate is a standardized guideline to predict risk and recommend management strategies for those at risk of ASCVD.
Our ASCVD Risk Algorithm is a step-wise approach for all adult patients – including those with known ASCVD. This calculator is for use only in adult patients without known ASCVD and LDL 70-189 mg/dL (1.81-4.90 mmol/L).
十三、ATRIA Bleeding Risk Score（华法林出血风险评分）
Determines bleeding risk for patients on warfarin.
The ATRIA study sought to develop a risk stratification score to predict warfarin-associated hemorrhage.
The ATRIA risk scoring scheme, in combination with other risk stratification scores and physician gestalt, can be used to help guide the decision for warfarin therapy in patients in need of anticoagulation.
The ATRIA risk scoring scheme may be used as one potential tool to stratify the risk of major hemorrhage in patients in whom warfarin anticoagulation is being considered.
Considers major and minor risk of hemorrhage and bleeding in patients prior to beginning warfarin therapy。
十四、Duke Criteria for Infective Endocarditis(感染性心内膜炎Duke评分)
Diagnostic criteria for infective endocarditis.
Duke评分诊断标准相信很多人都不陌生，只是看你很多记不住，但是，记不住没有关系，看看这个软件即可。
http://www.mdcalc.com/duke-criteria-infective-endocarditis/
十五、Wells’ Criteria for Pulmonary Embolism（肺动脉栓塞Wells诊断评分）
Objectifies risk of pulmonary embolism.
The Wells’ Criteria risk stratifies patients for pulmonary embolism (PE) and provides an estimated pre-test probability. The physician can then chose what further testing is required for diagnosing pulmonary embolism (I.E. d-dimer or CT angiogram).
The Wells’ Score has been validated multiple times in multiple clinical settings.
Physicians have a low threshold to test for pulmonary embolism.
The score is simple to use and provides clear cutoffs for the predicted probability of pulmonary embolism.
The score aids in potentially reducing the number of CTAs performed on low-risk PE patients.
http://www.mdcalc.com/wells-criteria-pulmonary-embolism-pe/
看到这里，相信很多人可能都在明白MDCALC（http://www.mdcalc.com/）的用处了，因为上面好几个评分都是来源于此软件。这个软件里只是有心血管的各种评分和诊断原则，还是其他Allergy and Immunology、Anesthesiology、
Critical Care (Neonatal)、Critical Care (Neurologic)、Critical Care (Pediatric)
、Dermatology、Emergency、Endocrinology、Family Practice、Gastroenterology、Geriatrics、Hematology and Oncology、Hepatology、Hospitalist Medicine、Infectious Disease和Internal Medicine等多种，基本应有尽有，只是没有像FRS那样的专业。其最常用的的：
而且其中一些常见的计算和评分等还有中文版，不过是繁体：
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