SYNTAX Ⅱ评分系统指导分站式杂交冠状动脉血运重建术策略的可行性研究  

Feasibility study of SYNTAX Ⅱ score in guiding the strategy of two-staged hybrid coronary artery revascularization

作　　者：徐昕晔[1] 凌云鹏[2] 郭丽君[1] 

机构地区：[1]北京大学第三医院心内科卫生部心血管分子生物学与调节肽卫生部重点实验室分子心血管教育部重点实验室,北京100191 [2]北京大学第三医院心外科,北京100191

出　　处：《中国介入心脏病学杂志》2019年第1期16-22,共7页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金(青年基金)(81400293);北京大学第三医院临床重点项目(BYSY2015007)

摘　　要：目的通过分站式杂交冠状动脉血运重建术(hybrid coronary revascularizasion,HCR)SYNTAXⅠ评分特征进行分析和观察不同阶段SYNTAXⅡ评分变化,评价依据术前SYNTAXⅡ评分选择HCR手术策略的可行性。方法回顾性分析2016年1月1日至2017年12月31日在北京大学第三医院接受分站式HCR的患者共50例,计算微创冠状动脉旁路移植术(minimally invasive direct coronary artery bypass grafting,MIDCAB)前总SYNTAXⅠ评分,据此计算术后SYNTAXⅠ评分及预估SYNTAXⅡ评分,比较预估的MIDCAB术后SYNTAXⅡ评分与实际SYNTAXⅡ评分的差异。结果在MIDCAB术前SYNTAXⅠ评分为36.00(13.00,70.50)分,SYNTAXⅠ评分>33分患者29例(58.0%),MIDCAB术后残余病变SYNTAXⅠ评分为11.50(7.00,18.50)分,较术前SYNTAXⅠ评分降低21.50(9.0,27.50)分。MIDCAB术前肌酐清除率(Ccr)为72.53(32.00,137.03)ml/min,术后复查Ccr为82.48(33.05,145.00)ml/min,较MIDCAB术前增加了8.87(–20.12,41.73)ml/min(P<0.001)。MIDCAB术前预测术后SYNTAXⅡ[经皮冠状动脉介入治疗(PCI)]评分为27.25(15.80,45.90)分,实际评分为27.20(15.90,52.30)分,增加了1.60(–4.80,11.40)分,差异有统计学意义(P=0.001);术前预测行PCI的4年死亡率为5.45%(2.00%,23.50%),实际死亡率为5.40%(2.10%,36.90%),增加了0.6%(–5.40%,13.40%),差异有统计学意义(P<0.001)。MIDCAB术前预测术后SYNTAXⅡ[冠状动脉旁路移植术(CABG)]评分为23.20(5.20,43.70)分,实际评分为23.65(4.20,40.70)分,增加了0.60(–6.30,5.70)分,差异有统计学意义(P=0.023);术前预测行CABG的4年死亡率为3.90%(0.90%,20.10%),实际死亡率为4.05%(0.80%,15.90%),增加了0.20%(–7.60%,3.00%),差异有统计学意义(P=0.044)。根据MIDCAB术前预估的SYNTAXⅡ评分,10.0%(5/50)患者行PCI术后4年死亡率低于CABG;对MIDCAB术后SYNTAXⅡ评分进行预测,该比例为38.0%(19/50),而实际比例为42.0%(21/50),预测值与实际值相符合的比例为90%(45/50,P=0.125)。结论预估MIDCAB术后SYNTAXⅡ评分指导手术策略�Objective To evaluate the feasibility of selecting the hybrid operation strategy according to the preoperative SYNTAX Ⅱ score by analyzing the characteristics of the SYNTAX score and the changes of the SYNTAX Ⅱ score in the different stages of the hybrid coronary artery bypass surgery.Methods Patients admitted in our hospital from Jan 1,2016 to December 31,2017 who received staged hybrid coronary revascularization(first stage CABG,followed by second stage PCI)were reviewed.The total SYNTAX Ⅱ scores before and after minimally invasive direct coronary artery bypass grafting(MIDCAB)were compared.Results A total of 50 patients were analyzed and scored by coronary angiography with lumen stenosis exceeding 50%.The SYNTAX Ⅰ score before MIDCAB was 36.00 points(13.00,70.50)and the ratio of SYNTAX Ⅰ score>33 points was 58%(29/50).After MIDCAB operation,the residual SYNTAX Ⅰ score was 11.50 points(7.00,18.50),which decreased by 25.50 points(19.00,33.75).According to the SYNTAX Ⅱ score before MIDCAB,a proportion of 10%(5/50)patients who received PCI procedure showed a lower 4-year mortality than the CABG operation.The forecasted proportion SYNTAX Ⅱ score after MIDCAB increased to 38%(19/50)while the actual proportion after MIDCAB was 42%(21/50).The consistency between the forecasted value and the actual value was 90%(45/50,P=0.125,McNemar test).Conclusions Using SYNTAX Ⅱ score to predict PCI or CABG treatment after MIDCAB is feasiable.The changes in SYNTAX Ⅱ score before and after MIDCAB was mainly resulted from the improvement in creatinine level after operation.

关 键 词：杂交冠状动脉血运重建术 SYNTAX Ⅰ评分 微创冠状动脉旁路移植术 

分 类 号：R543.3[医药卫生—心血管疾病]