SYNTAX Ⅱ评分对急性ST段抬高型心肌梗死患者直接PCI术后无复流的预测价值  

Value of SYNTAX score Ⅱ to predict no-reflow of prior percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

作　　者：郝鹏[1] 冯斯婷[1] 甄雷[1] 王晓[1] 王春梅[1] 聂绍平[1] Hao Peng;Feng Siting;Zhen Lei;Wang Xiao;Wang Chunmei;Nie Shaoping(Emergency Critical Care Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院急诊危重症中心

出　　处：《首都医科大学学报》2019年第5期744-748,共5页Journal of Capital Medical University

基　　金：国家自然科学基金面上项目(81670222);北京市医管局重点医学专业发展计划(ZYLX201710);北京市医管局“登峰”人才培养计划(DFL20180601)~~

摘　　要：目的评价SYNTAX评分与SYNTAXⅡ评分在预测急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,pPCI)后无复流现象的价值。方法选取2016年1月至2017年1月就诊于首都医科大学附属北京安贞医院急诊危重症中心,且发病12 h内经冠状动脉造影确定需行pPCI的STEMI患者,共计384例,按照pPCI术后是否发生无复流现象分为无复流组(76例)与正常血流组(308例)。对所有入选对象分别进行SYNTAX评分和SYNTAX II评分,并收集相关的临床特征及实验室检查资料。通过单因素及多因素Logistics回归分析及受试者工作特征(receiver operating characteristic,ROC)曲线分析,比较SYNTAX评分与SYNTAX评分II两种评分方法对STEMI患者冠状动脉无复流现象的预测价值。结果单因素分析SYNTAX评分及SYNTAX II评分均与冠状动脉无复流现象有关,但多因素分析只有SYNTAX II评分与无复流现象由关联,SYNTAX II评分高,发生冠状动脉无复流现象的危险性增加;ROC曲线分析显示SYNTAX评分II曲线下面积>SYNTAX评分,差异有统计学意义(0.905 vs 0.818,P<0.001),预测无复流现象的敏感度和特异度高于SYNTAX评分。结论SYNTAX II评分高分是无复流现象发生的独立影响因素,与SYNTAX评分相比,有更好的预测价值。Objective To assess the value of SYNTAX score and SYNTAXⅡscore to predict no-reflow of primary percutaneous coronary intervention(pPCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 384 STEMI patients who were diagnosed by coronary angiography within 12 hours were enrolled in the Emergency Critical Care Center of Beijing Anzhen Hospital from January 2016 to January 2017 in this study.No-reflow group(76 cases)and normal blood flow group(308 cases)are divided by reflux phenomenon.SYNTAX score and SYNTAXⅡscore were calculated,and the clinical features and laboratory data were collected to compare the differences between groups.Logistics regression analysis was assessed of no-reflow factors,and receiver operating characteristic(ROC)curve analysis was compared the SYNTAX score with SYNTAXⅡscore in predictive value of no-reflow phenomenon in STEMI patients.Results Through univariate analysis,SYNTAX score and SYNTAXⅡscore were all correlated with no reflow of coronary arteries,but only SYNTAXⅡscore was correlated with no reflow of coronary arteries in multivariate analysis.With high SYNTAXⅡscore,the risk of coronary non-reflow increased.ROC curve analysis showed that the area under curve of SYNTAX scoreⅡwas larger than SYNTAX score,and the difference was statistically significant(0.905 vs 0.818,P<0.001).Furthermore,the sensitivity and specificity of predicting no reflow were higher than SYNTAX score.Conclusion The SYNTAXⅡscore was an independent risk factor of no-reflow and had a better predictive value of no-reflow than the SYNTAX score in STEMI patients.

关 键 词：SYNTAX评分 SYNTAX评分Ⅱ 急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 预测 

分 类 号：R541.4[医药卫生—心血管疾病]