SYNTAX积分在合并冠状动脉多支血管病变的STEMI患者急诊PCI策略中的应用  

Application of SYNTAX score in emergency PCI strategy for STEMI patients with multivessel diseases

作　　者：张波[1] 赵晓辉[2] 晋军[2] 

机构地区：[1]三峡大学仁和医院心内科,湖北宜昌443001 [2]第三军医大学新桥医院全军心血管病研究所,重庆400037

出　　处：《重庆医学》2016年第21期2949-2952,共4页Chongqing medicine

摘　　要：目的分析心脏外科与介入治疗狭窄冠状动脉研究(SYNTAX)积分在伴有冠状动脉多支血管病变(MVD)的ST段抬高型心肌梗死(STEMI)患者急诊血运重建策略选择中的作用,并分析患者预后及影响因素。方法收集第三军医大学新桥医院2010年8月至2012年3月收治的行急诊经皮冠状动脉介入术(PCI)且经冠状动脉造影证实为伴有MVD的STEMI患者144例,按不同急诊PCI策略将其分为单次完全血运重建组(CR组)、分期完全血运重建组(SR组)、不完全血运重建组(IR组)。记录患者的基础临床情况及冠状动脉SYNTAX积分值,随访12个月统计主要不良心脑血管事件(MACCE)发生率,收集复查冠状动脉造影结果,分析不同策略患者预后的影响,以及影响患者预后的危险因素。结果 IR组与CR组及SR组比较,全因死亡率差异无统计学意义(P>0.05),而脑血管事件、住院期间再次血运重建、急性心肌梗死及MACCE的发生率比较,差异均有统计学意义(P<0.05)。影响MACCE的主要因素是合并糖尿病、C型病变、SYNTAX评分、门球时间,心肌梗死面积、PCI术中心肌梗死溶栓试验(TIMI)评分、存在无复流及心源性休克(P<0.05)。根据SYNTAX评分,轻度或重度病变时3组患者MACCE发生率比较差异无统计学意义(P>0.05);而中度病变时,3组患者MACCE发生率比较差异有统计学意义(P<0.05),CR组MACCE发生率最高。结论对于伴有MVD的STEMI患者,SYNTAX评分可作为再灌注策略选择的依据应用于急诊PCI。Objective To evaluate the effect of SYNTAX score in the emergency revascularization strategy selection in STsegment elevation myocardial infarction patients with multi-vessel disease（MVD）and to analyze the patient′s prognosis and influencing factors.Methods A total of 144 patients with STEMI complicating MVD verified by coronary arterial angiography in the Xinqiao Hospital of Third Military Medical University from August 2010 to March 2012 were collected and divided into the once complete revascularization group（CR group）,staged complete revascularization group（SR group）and incomplete revascularization group（IR group）according to different emergency PCI strategies.The basic clinical conditions and coronary arterial SYNTAX score were recorded.The occurrence rate of major adverse cardiovascular events（MACCE）during 12 months follow up period was performed the statistics.The results of coronary arterial angiography were collected.The effect of different strategy on prognosis and the risk factors affecting prognosis were analyzed.Results There was no statistically significant difference in the all-cause mortality between the IR group with the CR and SR groups（P〈0.05）,while the cerebrovascular event,repeat revascularization during hospitalization,AMI and total MACCE occurrence rate had statistical difference between the IR group with the CR and SR groups（P〈0.05）.The main influence factors of MACCE were complicating diabetes mellitus,type C lesions,SYNTAX score,D-B time,myocardial infarction area,TIMI score in PCI,no reflow existence and cardiac shock（P〈0.05）.According to the SYNTAX score,the occurrence rate of MACCE in mild or severe lesions had no statistical difference among 3groups（P〈0.05）,while which in moderate lesion had statistical difference among 3groups（P〈0.05）,the CR group had the highest occurrence rate of MACCE.Conclusion For the patients with STEMI complicating MVD,the SYNTAX score can be used as the evidence for selecting reperfusion strategies and appl

关 键 词：冠状动脉多支血管病变 ST段抬高型心肌梗死 急诊血运重建 单次完全性血运重建 分期完全性血运重建 不完全血运重建 

分 类 号：R542.22[医药卫生—心血管疾病]