Objective To investigate the ability of SYNTAX score (SS),clinical SYNTAX score (CSS) and residual SYNTAX score (RSS) regarding predicting one year major adverse cardiac and cerebrovascular events (MACCE) rates in octogenarian patients with multivessel coronary artery disease undergoing percutaneous coronary intervention(PCI).Methods The data of over 80 years old patients with multivessellesion undergoing PCI from January 2010 to January 2012 were retrospectively analyzed.The SS and RSS were calculated before and after PCI.The CSS was calculated using age,left ventricular ejection fraction (LVEF),creatinine clearance and SS.Tertiles for SS,CSS and RSS were defined as SSlow ≤ 13,13 ＜ SSmid ≤ 20 and SShigh ＞ 20,CSSlow 31,31 ＜ CSSmid ≤ 57and CSShigh ＞ 57,RSSlow ≤ 2,2 ＜ RSSmid ≤ 9 and RSShigh ＞ 9,respectively.Major adverse cardiovascular events (MACCE) rates (all-cause mortality,nonfatal myocardial infarction,target vessel revascularization and stroke)were followed-up at one year.Results Among 199 cases,13 cases were lost to follow-up,SSlow group had 62 cases,SSmid group had 63 cases,SShigh group had 61 cases; RSSIow group had 65 cases,RSSmid group had 61 cases,RSShigh group had 60 cases; CSSIow group had 64 cases,CSSmid group had 61 cases,CSShigh group had 61 cases.MACCE rate was 12.9％ (8 cases),23.8％ (15 cases) and 41.0％ (25 cases) in SSlow,SSmid and SShigh group,respectively.MACCE rate was 17.2％ (11 cases),21.3％ (13 cases) and 39.3％ (24 cases) in CSSlow,CSSmid and CSShigh group,respectively.MACCE rate was 20.0％ (13 cases),29.5％ (18 cases) and 28.3％ (17 cases)in RSSlow,RSSmid and RSShigh group,respectively.Patients in the high tertiles of SS and CSS experienced significant elevated MACCE compared with low and middle tertiles (all P ＜ 0.05).By multivariable Cox-regression analysis,SS(HR:1.28,95％CI:1.08-1.56,P=0.01) and CSS (HR:1.07,95％CI:1.04-1.10,P =0.01)were independent predictors of 1-year MACCE.Receiver-operator characteristic (ROC) curve analysis showed both SS[area under curve (AUC) =0.710 (95％ CI:0.629-0.791),P =0.001] and CSS [AUC =0.687,95％ CI:0.597-0.777,P =0.001] had predictive value of MACCE in octogenarian patients with multivessel coronary artery disease undergoing PCI.Conclusion SS and CSS are able to stratify risks for one year MACCE in octogenarian patients with multvessel coronary artery disease undergoing PCI.While considering the three important clinical factors,and CSS integral prediction effect is not better than that of the SYNTAX score.%目的 比较经皮冠状动脉TAXUS支架置入术与心脏外科手术协作研究(SYNTAX)积分、临床SYNTAX积分和残余SYNTAX积分对80岁以上高龄、多支血管病变患者经皮冠状动脉介入治疗术后1年主要不良心脑血管事件(MACCE)的预测价值.方法 回顾性分析从2010年1月至2012年1月因心绞痛接受经皮冠状动脉介入治疗的80岁及以上、多支血管病变的患者199例.根据经皮冠状动脉介入术前和术后冠状动脉造影结果计算SYNTAX积分和残余SYNTAX积分.根据SYNTAX积分,结合患者的年龄、左心室射血分数和肌酐清除率计算临床SYNTAX积分.根据3种积分的数值分别按照三分位法将患者分为低分组、中分组和高分组.随访1年,观察3种积分对MACCE(包括死亡、非致死性心肌梗死、再次血运重建、脑卒中)的预测作用.结果 199例中失访13例,SYNTAX积分低分组62例,中分组63例,高分组61例;残余SYNTAX积分低分组65例,中分组61例,高分组60例;临床SYNTAX积分低分组64例,中分组61例,高分组61例.SYNTAX积分低分、中分、高分组MACCE发生率分别为12.9％(8例),23.8％(15例)和41.0％(25例),高分组患者MACCE发生率明显高于低分组(P=0.001)和中分组(P=0.040);临床SYNTAX积分低分、中分、高分组MACCE发生率分别为17.2％(11例),21.3％(13例)和39.3％(24例),高分组MACCE发生率也明显高于低分组(P=0.009)和中分组(P=0.040);残余SYNTAX积分低分、中分、高分组主要MACCE发生率分别为20.0％(13例),29.5％(18例)和28.3％(17例),差异无统计学意义.COX-多因素回归分析显示SYNTAX积分(危险比为1.28,95％置信区间:1.08 ～1.56,P=0.01)及临床SYNTAX积分(危险比为1.07,95％置信区间:1.04～1.10,P=0.01)是MACCE的独立预测因素.受试者工作特征曲线分析,SYNTAX积分曲线下面积=0.710(95％置信区间:0.629 ～0.791,P=0.001);临床SYNTAX积分曲线下面积=0.687(95％置信区间:0.597～0.777,P=0.001),二者对MACCE均有预测价值,但是临床SYNTAX积分预测MACCE的准确性低于SYNTAX积分.结论 SYNTAX积分和临床SYNTAX积分对高龄、多支血管病变PCI治疗后1年MACCE有预测作用.虽然考虑了3个重要的临床因素,但是临床SYNTAX积分的预测作用并不优于SYNTAX积分.
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