临床SYNTAX积分对急性冠脉综合征患者介入治疗后远期临床结局的预测价值  

Predicting value of clinical SYNTAX score on long-term prognostic clinical outcomes in patients with acute coronary syndrome after percutaneous coronary intervention

作　　者：安丽丽[1] 黄文正[1] 张新梅[1] 王莉[1] 李亚光[1] AN Li-li;HUANG Wen-zheng;ZHANG Xin-mei;WANG Li;LI Ya-guang(Cardiovascular Department of Internal Medicine,Hebei Central Energy Fengfeng Group General Hospital,Han.dan,Hebei 056002,China)

机构地区：[1]冀中能源峰峰集团总医院邯郸院区心内科,河北邯郸056002

出　　处：《岭南心血管病杂志》2018年第4期402-407,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的分析临床SYNTAX积分(clinical SYNTAX score,CSS)对急性冠状动脉(冠脉)综合征患者介入治疗后远期主要不良心血管事件(major adverse cardiovascular events,MACE)的预测价值。方法回顾性分析自2008年1月至2013年12月于冀中能源峰峰集团总医院行介入治疗的1 191例急性冠脉综合征患者的临床资料。根据CSS的数值,分为低CSS组,中CSS组和高CSS组。对3组患者的基线资料、介入治疗资料以及2年的随访结果进行比较。结果与低CSS组相比,高CSS组的年龄更大,血管病变越复杂,有更多的复杂并发症;高CSS组合并复杂造影特征的患者比例更高,介入成功率更低,介入时间更长,住院时间更长,差异均有统计学意义(P<0.05)。2年随访发现,高CSS组病死率明显高于中CSS组和低CSS组,差异均有统计学意义(P<0.05)。多因素回顾分析结果发现,死亡的独立预测因子包括CSS。MACE的独立预测因子包括CSS、主动脉内球囊反搏植入,高脂血症,经皮冠状动脉介入治疗成功率、介入时间。受试者工作特征曲线分析提示,对于2年病死率,CSS的预测效果明显优于基线SYNTAX积分和残余SYNTAX积分;但对于2年MACE,CSS并不优于基线SYNTAX积分和残余SNYTAX积分。结论对于急性冠脉综合征并行介入治疗的患者来说,CSS是一个非常有效的风险评估工具,并可以较为准确地预测2年死亡风险。Objectives To observe and evaluate the predicting value of clinical SYNTAX score(CSS)affecting the long-term prognostic outcomes in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods From January 2008 to December 2013,1 191 consecutive ACS patients admitted to Fengfeng Group General hospital and underwent PCI were enrolled in this study.Accordingly to CSS,patients were divided in low CSS group,moderate CSS group and high CSS group.Clinical basic data,intervention data and 2-year follow-up results were compared among the 3 groups.Results Compared with patients in low CSS group,those in the high CSS group were older,and were more likely to have more complicated vascular disease and complex comorbidities(P<0.05);high CSS group had a more complex angiographic characteristics,lower intervention success rate,longer intervention procedural duration and in-hospital duration(P<0.05).The 2-year follow-up showed that cardiac death rate of high CSS group was significantly higher than those of low CSS group and moderate CSS group(P<0.05).In multivariate analysis,the independent predictor of cardiac death was CSS.In multivariate COX analysis,increasing CSS was an independent predictor of major adverse cardiovascular events(MACE),along with intra-aortic balloon pump(IABP)implementation,hypercholesterolemia,successful PCI,procedural duration.Receiver operating characteristic(ROC)curves analysis indicated that CSS was superior to baseline SYNTAX score and residual SYNTAX score in predicting 2-year cardiac death,but wasn′t superior in predicting 2-year MACE.Conclusions CSS was suitable in risk stratifying and predicting 2-year clinical outcome in patients with ACS undergoing percutaneous coronary intervention.

关 键 词：冠状动脉疾病 临床SYNTAX积分 介入治疗后 远期预后 

分 类 号：R541.4[医药卫生—心血管疾病]