SYNTAX评分预测急性ST段抬高型心肌梗死介入后无复流  

SYNTAX score is associated with no reflow in patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

作　　者：王锦纹[1] 陈韵岱[2] 王长华[3] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所人群防治研究室,北京100029 [2]解放军总医院心内科 [3]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,北京100029

出　　处：《心肺血管病杂志》2013年第5期557-560,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市科委科技计划项目(Z121107001012002)

摘　　要：目的:评价急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者诊断性冠状动脉造影获得的SYNTAX评分,与经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后无复流现象的相关性。方法:入选在发病后12h内行PCI治疗的397例STEMI患者,进行回顾性分析。根据单纯冠状动脉病变心脏外科与介入治疗狭窄冠状动脉研究(Synergy between percutaneous coronary intervention with TAXUS and cardiac surgery,SYNTAX)评分的中位数,将患者分为高分组和低分组。将冠状动脉造影结果作为无复流的判断标准。采用多元Logistic回归分析,评价SYNTAX评分与急诊PCI后无复流现象的的相关性。结果:PCI术后发生无复流现象的患者共79例(19.9%),其中SYNTAX评分高分组无复流发生率显著高于低分组。多元Logistic回归分析显示,年龄≥55岁(OR=2.46,95%CI=1.72～3.41;P<0.001)、入院前服用β阻滞剂(OR=0.62,95%CI=0.41～0.92;P=0.021)、术前Killip分级(4级,OR=3.78,95%CI=2.14～6.48;P<0.001)、再灌注时间(≥2h,OR=1.37,95%CI=1.02～1.79;P=0.036)、及SYNTAX评分≥15.75(OR=1.16,95%CI=1.01～2.45;P<0.001)是直接PCI术无复流现象的独立预测因素。结论:STEMI患者急诊PCI前通过冠状动脉造影获得的SYNTAX评分对于预测STEMI患者PCI后无复流现象并进行危险分层具有一定参考价值。Objective： To assess the no-reflow and its possible relationships with the SYNTAX （Syner- gy between percutaneous coronary intervention with Taxus and cardiac surgery） score （SXscore） and clinical characteristics in patients with ST-segment elevation myocardial infarction （STEMI） treated with primary percu- taneous coronary intervention （PCI）. Methods： In this study, 397 patients with STEMI treated with PCI were analyzed retrospectively. The SXscore, thrombolysis in myocardial infarction （TIMI） flow grade score were de- termined in all patients. Patients were divided into two groups based upon the median SXscore. Angiographic no-reflow can be defined as a TIMI flow grade 〈 3. The association of SXscore obtained on diagnostic angiogra- phy during PCI with no reflow phenomenon after PCI was assessed by multivariate logistic regression. Results： The no reflow was found in 79 patients （ 19. 9% ） of 397 patients. The IRA more often had poor anterograde flow （TIMI grade 0 or 1 ） in patients with high SXscores. A multivariable logistic regression model revealed thatvariables strongly correlated with no-reflow were advanced age （ t〉55 years, odds ratio （OR） 2. 46, 95% con- fidence interval （CI） 1.72-3.41 ; P 〈 0. 001 ）, administration of beta-blocker （ OR O. 62, 95% C10. 41-0. 92 ; P =0. 021 ）, Killip classes （4, OR 3.78, 95% CI 2. 14-6.48 ; P 〈 0. 001 ）, time from pain to PCI （ 〉2h, OR 1.37, 95% C11.02-1.79; P=0.036）, and SXscore〉15.75 （OR 1.16, 95% CI 1.01-2.45; P 〈 0. 001 ）. Conclusion： The SXscore obtained in the diagnostic phase of PCI can predict no-reflow after PCI in patients with STEMI.

关 键 词：急性ST段抬高型心肌梗死 SYNTAX评分 无复流 

分 类 号：R54[医药卫生—心血管疾病]