残余SYNTAX积分对急性冠状动脉综合征介入治疗预后分析  

Usefulness of the residual SYNTAX score to predict long term outcome in acute coronary syndrome patients underwent percutaneous coronary intervention

作　　者：宋莹[1] 许晶晶[1] 唐晓芳[1] 马元良[1] 姚懿[1] 何晨[1] 王欢欢[1] 刘如[1] 徐娜[1] 蒋萍[1] 姜琳[1] 赵雪燕[1] 高展[1] 高润霖[1] 乔树宾[1] 杨跃进[1] 徐波[2] 袁晋青[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心脏病中心阜外医院心内科,北京100037 [2]中国医学科学院北京协和医学院国家心脏病中心阜外医院介入中心,北京100037

出　　处：《中华医学杂志》2017年第7期502-507,共6页National Medical Journal of China

基　　金：国家自然科学基金（81470486）

摘　　要：目的探讨针对急性冠状动脉综合征（ACS）多支病变行经皮冠状动脉介入治疗（PCI）患者，使用残余SYNTAX积分（rSS）判断血运重建程度并探讨其对远期预后的影响。方法纳入2013年1至12月中国医学科学院阜外医院1 414例中、高危ACS合并多支病变行PCI患者。按rSS分为4组并比较4组间患者2年临床预后。结果平均rSS为（4.8±6.7）分。591例（41.8%）完全血运重建组（rSS=0）, 233例（16.5%）为低分组（0 〈rSS ≤ 3），296例（20.9%）为中分组（3 〈rSS ≤ 8），294例（20.8%）为高分组（rSS〉8）。rSS高分组合并更多临床高危因素。2年随访结果显示rSS高分组全因病死率显著高于其他3组（1.2%比0.4%、2.0%、4.4%，P=0.003），心源性死亡及主要不良心脑血管事件（MACCE）发生率也显著升高。Cox回归分析显示rSS是全因死亡（HR=1.05，95%CI 1.01-1.09, P=0.019）的独立危险因素，也是心源性死亡、血运重建及MACCE的独立危险因素。结论对于中高危ACS合并多支病变的患者，rSS是全因死亡、心源性死亡、血运重建及MACCE独立危险因素且有中等程度的预测价值。Objective To quantify the extent and complexity of residual coronary stenosis following PCI by the residual SYNTAX score, and to evaluate its impact on adverse ischemic outcomes in acute coronary syndrome （ACS） patients. Methods From January 2013 to December 2013, a total of 1 414 consecutive moderate- and high-risk ACS patients who underwent any PCI with multi-vessel coronary artery disease were evaluated. Patients were stratified by rSS quartiles and their outcomes were compared. Results The rSS was 4. 8 ± 6. 7. 591 patients （41.8%） had rSS=0（CR）, 233 patients （16.5%） had rSS〉0 but ≤ 3,296 patients （20. 9% ） had rSS 〉 3 but ≤8 and 294 patients （20. 8% ） had rSS 〉 8. Clinical risk factors were more frequent in patients with incomplete revascularization （IR） compared with complete revascularization（CR）. The 2-year rates of all-caused death（ 1.2% vs 0. 4% ,2. 0% ,4. 4%, P = 0. 003 ）, cardiac death, revascularization and MACCE were significantly higher in high rSS group, compared to other groups. By multivariable analysis, rSS was a strong independent predictor of ischemic outcomes at 2-year, including all-cause mortality （ HR = 1.05, 95% CI 1.01 - 1.09, P = 0.019 ） , cardiac death, revascularization and MACCE. Conclusions The rSS is a strong independent predictor of all-caused death,cardiac death, revascularization and MACCE and has moderated predictive ability for those ischemic outcomes.

关 键 词：残余SYNTAX积分 冠状动脉疾病 放射学 介入性 预后 

分 类 号：R541.4[医药卫生—心血管疾病]