冠状动脉分叉病变介入治疗中分支闭塞风险模型及评分系统的研究  

Risk Prediction Model and Scoring System Analysis in Patients With Side Branch Occlusion During Coronary Bifurcation Intervention

作　　者：何源[1] 张冬[1] 尹栋[1] 徐波[1] 窦克非[1] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外心血管病医院冠心病诊治中心,北京市100037

出　　处：《中国循环杂志》2015年第9期827-832,共6页Chinese Circulation Journal

基　　金：首都临床特色应用研究基金(Z141107002514096);北京协和医学院"协和青年基金"(33320140166)

摘　　要：目的：建立预测冠状动脉（冠脉）分叉病变介入治疗中分支闭塞风险模型及评分系统。方法：本研究对我院2012-01至2012-07连续7007例经皮冠脉介入治疗（PCI）患者进行筛选，入选以单支架或临时性双支架策略行PCI的分又病变患者1545例（共计1601处病变）。根据术中是否发生分支闭塞分为无分支闭塞组（n=1431例）和分支闭塞组（n=114例）。按时间顺序将1601处病变中前1200处作为建模数据集用于构建介入治疗中分支闭塞风险模型和评分系统，将后401处作为验证数据集进行验证。结果：建模数据集分析显示，术前主支血管斑块与分支血管位置关系、支架置入前主支血管心肌梗死溶栓治疗临床试验（TIMI）血流等级、术前分叉核直径狭窄程度、术前分叉角度、支架置入前分支直径狭窄程度和术前主支／分支血管直径比是分支闭塞的独立危险因素，风险模型的ROC曲线下面积0．80[95％可信区间（CI）：0．75～0．85]，Hosmer—Lemeshow法（HL）P=I．00；评分系统ROC曲线下面积0．76（95％CI：0．71～0．82），HLP=0．12。验证数据集检验风险模型的ROC曲线下面积0．81（95％CI：0．73～0．89），HLP=0．77；评分系统ROC曲线下面积0．77（95％CI：0．69～0．86），HLP=0．58。建模数据集和验证数据集患者评分系统积分四分位数划分结果显示评分积分≥10分患者分支闭塞发生率明显高于10分以下患者（P〈0．001），术中分支闭塞风险高。结论：本研究建立的评分系统简便易用，通过定量分析冠脉造影区分出分叉病变介入治疗中分支闭塞高风险患者。Objective： To establish a risk prediction model and scoring system in patients with side branch （SB） occlusion during coronary bifurcation intervention. Methods： A total of 7007 consecutive patients who received percutanenous coronary intervention （PCI） in our hospital from 2012-02 to 2012-07 were recruited and 1545 patients （with 1601 bifurcation lesions） treated by single stent technique or main vessel stenting first strategy were selected for our study. According to weather SB occlusion occurred during operation, the lesions were divided into 2 groups： Non-SB occlusion group, n=1431 and SB occlusion group, n=114. The data set of the first 1200/1601 lesions by time sequence, was used for establishing the risk model and scoring system, the data set of rest 401 lesions was used for model validation. Results： The modeling data set presented that the relationship between pre-operative main vessel plaque and the position of branch vessel, the main blood vessel pre-stenting TIMI grade, the stenosis degree of pre-operative bifurcation nucleus, the angle of pre-operative bifurcation and the ratio of pre-senting stenosis degree of branch diameter and pre-operative main vessel to branch vessel diameter were the independent risk factors for branch occlusion. The risk model ROC=0.80, 95% CI 0.75-0.85, Hosmer-Lemeshow HL P=1.00; the scoring system ROC=0.76, 95% CI 0.71-0.82, HL P=0.12. The validation dataset ROC=0.81, 95% CI 0.73-0.89, HL P-0.77; the scoring system ROC=0.77, 95% CI 0.69-0.86, HL P-0.58. The quartile integration of both data sets indicated that the patients with the integration score ≥ 10 had the higher risk for SB occlusion than those with integration score 〈 10 during the operation, P〈0.001. Conclusion： Our research developed a simple and user-friendly system, it may distinguish the patients with high risk of SB occlusion during bifurcation intervention by quantitative stratification of coronary angiographic imaging.

关 键 词：冠状动脉分叉病变 介入治疗策略 分支闭塞 风险预测 评分系统 

分 类 号：R541[医药卫生—心血管疾病]