不同分层标准SYNTAX积分对经皮冠状动脉介入治疗复杂冠心病患者的预测价值  

Predictive Values of Different SYNTAX Scores in Patients Undergoing Percutaneous Coronary Intervention for Complicated Coronary Artery Disease

作　　者：高阅春[1] 玉献鹏[1] 何继强[1] 吴长燕[1] 张晓玲[1] 李宇[1] 罗亚玮[1] 张宇晨[1] 张维东[1] 陈方[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京市心肺血管疾病研究所,北京市100029

出　　处：《中国全科医学》2012年第5期512-515,共4页Chinese General Practice

摘　　要：目的比较不同分层标准SYNTAX积分对经皮冠状动脉介入治疗(PCI)复杂冠心病患者临床预后的预测价值。方法选择2007年1月—2008年12月共190例三支病变和(或)左主干病变的冠心病患者根据其造影结果计算SYNTAX积分,分别按照本研究人群SYNTAX积分总体分布三分位数值划分及SYNTAX研究人群三分位数值划分的不同分数段SYNTAX积分研究患者的主要不良心脑血管事件(包括死亡、非致命性心肌梗死、再次血运重建、脑血管事件)发生率,比较两者对主要不良心脑血管事件的预测作用。结果 (1)按照本研究人群SYNTAX积分总体分布三分位数值划分低分组(0～20.5)、中分组(21.0～31.0)及高分组(≥31.5)的主要不良心脑血管事件发生率分别为9.1%、16.2%及30.9%,SYNTAX积分能预测MACCE发生率(log rank P=0.006),多因素Cox比例风险回归分析结果显示,SYNTAX积分仍可预测MACCE发生率〔HR=2.07,95%CI(1.25,3.44),P=0.005〕;ROC曲线下面积=0.667〔95%CI(0.564,0.770),P=0.004〕。(2)按照SYNTAX研究人群三分位数值划分低分组(0～22)、中分组(23～32)及高分组(≥33)的主要不良心脑血管事件率分别为15.7%、12.9%及28.6%,此划分法不能预测MACCE的发生率(log rank P=0.09),多因素Cox比例风险回归分析结果显示,根据SYNTAX研究的分数段划分方法不能预测本人群MACCE发生率〔HR=1.47,95%CI(0.94,2.32),P=0.10〕;ROC曲线下面积=0.593〔95%CI(0.475,0.710),P=0.11〕。结论对于本研究190例三支病变和(或)左主干病变经PCI治疗的患者,根据本研究SYNTAX积分总体分布三分位数值的划分法(0～20.5,21.0～31.0,≥31.5)对MACCE有预测作用,而SYNTAX研究中的三分位数值划分法(0～22,23～32,≥33)对MACCE无预测作用。Objective To compare the predictive values of different SYNTAX scores in patients undergoing percutaneous coronary intervention for complicated coronary artery disease.Methods SYNTAX scores were retrospectively calculated in 190 patients with three-vessel or left-main coronary artery disease from January 2007 to December 2008.Follow-up was carried out by telephone or outpatient visits.The research endpoints included major adverse cardiac or cerebrovascular events（MACCE）,a composite of death,nonfatal myocardial infarction（MI）,stroke,and repeat revascularization.MACCE rates according to different stratification of SYNTAX scores were recorded respectively.Cox proportional hazards model was used to calculate hazard ratios and their corresponding 95% CIs and control the confounding factors.Area under receiving operator curve（AUROC） were calculated to compare the predictive values of these two different stratifications.Results The MACCE rates of low（0~20.5）,intermediate（21.0~31.0）,and high（≥31.5） tertiles according to SYNTAX score of our study population were 9.1%,16.2%,and 30.9%,respectively（Log rank P=0.006）,multivariable analyses（HR=2.07,95% CI（1.25,3.44）,P=0.005）;the AUROC was 0.667（95%CI（0.564,0.770）,P=0.004）.The MACCE rates of low（0~22）,intermediate（23~32）,and high（≥33） tertiles according to SYNTAX scores of SYNTAX study were 15.7%、12.9%,and 28.6% respectively（Log rank P=0.09,multivariable analyses HR=1.47,95%CI（0.94,2.32）,P=0.10）;the AUROC was 0.593（95%CI（0.475,0.710）,P=0.11）.Conclusion SYNTAX score tertiles according to overall SYNTAX score distribution of our study population（0~20.5,21.0~31.0,≥31.5） can be an independent predictor of MACCE.However,SYNTAX score tertiles according to SYNTAX study（0~22,23~32,≥33）fail to predict MACCE occurrence of our study population.

关 键 词：SYNTAX积分 血管成形术 经腔 经皮冠状动脉 冠心病 SYNTAX研究 预测 主要不良心脑血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]