定量血流储备分数指导的SYNTAX-Ⅱ评分对老年多支血管病变患者预后的预测价值  

The predictive value of SYNTAX-II score guided by quantitative flow ratio for prognosis in elderly patients with multi-vessel disease

作　　者：王鸣 干倩 翟馨蓉 张舒怡 徐逸婷 关韶峰 陈阳[1] 容耀聪[1] 张亮[1] 李天奇[1] 常锡峰[1] 翁婷雯[1] 曲新凯 韩文正 Wang Ming;Gan Qian;Zhai Xinrong;Zhang Shuyi;Xu Yiting;Guan Shaofeng;Chen Yang;Rong Yaocong;Zhang Liang;Li Tianqi;Chang Xifeng;Weng Tingwen;Qu Xinkai;Han Wenzheng(Department of Cardiology,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China;Department of Intensive Care Unit,Tongren Hospital Affiliated to Medical College of Shanghai Jiaotong University,Shanghai,200050,P.R.China)

机构地区：[1]复旦大学附属华东医院心血管内科,上海200040 [2]上海交通大学医学院附属同仁医院重症医学科,上海200050

出　　处：《老年医学与保健》2024年第3期774-780,共7页Geriatrics & Health Care

基　　金：上海市卫生健康委员会科研课题(202040298);华东医院临床研究项目(HDLC2022014)。

摘　　要：目的探讨定量血流储备分数(QFR)指导的SYNTAX-Ⅱ评分(QFR-SSⅡ)对老年多支血管病变患者完全血运重建后预后的预测价值。方法回顾性分析2021年1月1日—2022年12月31日在复旦大学附属华东医院接受冠脉造影证实多支血管病变且已完全行血运重建的老年患者(≥75岁),共120例。基于冠脉造影及临床因素进行SYNTAX-Ⅱ评分(SSⅡ),同时对于QFR<0.80病变进行校正指导后的SYNTAX-Ⅱ评分。主要心血管不良事件(MACE)定义为2年随访的心源性死亡、心肌梗死及缺血驱动的再次血运重建。分析QFR-SSⅡ不同危险分层分组的MACE发生率及其对于MACE事件的预测价值。结果研究发现,通过ROC曲线分析,可采用≤28,>28且<38,≥38为危险分层标准。QFR-SSⅡ校正后,危险分层低危组比例由SSⅡ分层的28.33%上升至32.50%,中危组由55.83%降低至54.17%,高危组由15.84%降低至13.33%。QFR-SSⅡ标准下高危组的主要终点事件发生率要显著高于其他组(P=0.001)。QFR-SSⅡ(HR[95%CI]:1.066[1.019~1.115],P=0.006)及SSⅡ(HR[95%CI]:1.071[1.023~1.122],P=0.003)均对主要终点具有较好的预测价值。结论无论SSⅡ或QFR-SSⅡ对多支病变患者预后均有良好的预测价值,QFR-SSⅡ通过优化生理学标准校正对老年多支血管病变患者治疗预后更具有指导价值。Objective To investigate the predictive value of SYNTAX-Ⅱ(SSⅡ)score guided by quantitative flow ratio(QFR)for prognosis in elderly patients with multi-vessel disease.Methods A retrospective analysis was performed on 120 elderly patients(≥75 years old)who underwent coronary angiography and were confirmed to have multi-vessel lesions,and had undergone complete revascularization in Huadong Hospital Affiliated to Fudan University from January 1,2021 to December 31,2022.SSⅡ score was performed based on coronary angiography and clinical factors,and then the SSⅡ score was re-performed after correction guidance for the lesions with QFR<0.80.Major adverse cardiovascular events(MACE)were defined as cardiac death,myocardial infarction,and ischemia-driven revascularization during a 2-year follow-up.The incidence of MACE in different risk stratification groups of QFR-SSII and its predictive value for MACE were analyzed.Results It was found that through ROC curve analysis,the risk stratification criteria of QFR-SSⅡ could be≤28,>28 and<38,≥38.After QFR-SSII correction,the proportion of the low-risk group increased from 28.33% to 32.50%,the proportion of medium-risk group decreased from 55.83%to 54.17%,and the proportion of high-risk group decreased from 15.84% to 13.33%.The incidence of MACE in the high-risk group was significantly higher than that in other groups(P=0.001).Both QFR-SSII(HR[95%CI]:1.066[1.019-1.115],P=0.006)and SSⅡ(HR[95%CI]:1.071[1.023-1.122],P=0.003)had good predictive value for MACE.Conclusion Both SSⅡ and QFR-SSⅡ have good predictive value for the prognosis of patients with multi-vessel lesions.QFR-SSⅡ has more guiding value in the treatment and prognosis of elderly patients with multi-vessel disease by optimizing physiological standard correction.

关 键 词：老年 定量血流储备分数 SYNTAXⅡ评分 多支血管病变 

分 类 号：R543.3[医药卫生—心血管疾病]