SYNTAX评分对无保护左主干病变选择不同血运重建方式的价值研究

摘要

Resull:①The basic informalion and left main lesion characlerislics with syntax score were similar belween Lwo groups,P> 0. 05. While there were more palienls with 3-vessel disease in CABG group than ihose in PCI-DES group,P<0. 01. ②The in-hos-pital MACCE occurrence rale was higher in CABG group lhan that in PCI-DES group,P<0.05. For 3 years follow-up, the MACCE occurrence and MACCE free survival rale were no real differences belween two groups. The revascularizalion rale was higher in PCI-DES group,P<0.05. ③The synlax score had no real difference belween lwo groups,P>0. 05. Al 3 years after the operalion, in PCI-DES group, the high score palienls had increased MACCE occurrence and decreased MACCE free survival rale than low score palienls,P<0. 01 respectively,while in CABG group,there were no slalislic differences,P>0. 05. In high score palients,PCI-DES group had increased MACCE occurrence and decreased MACCE free survival rale lhan CABG group,P<0. 05 respectively. In low score palienls,PCI-DES group had decreased MACCE occurrence and increased MACCE free survival rale lhan CABG group, P<0. 05 respectively.Conclusion; Synlax score syslem is valuable for selecting the optimal revascularizalion stralegies in patienls with ULMCA dis-ease, it is imporlant to make proper revascularizalion in differenl patienl.%目的:应用SYNTAX评分评估冠状动脉(冠脉)无保护左主干病变(ULMCA)的复杂程度及其与临床事件的相关性,探讨冠脉无保护左主干病变患者的最佳血运重建方式.方法:回顾性收集了206例从2003-02至2008-O1采用经皮冠脉介入治疗-药物洗脱支架(PCI-DES)和冠脉旁路移植术(CABG)的无保护左主干病变患者,其中CABG组94例,PCI-DES组112例.收集患者的基本情况、左主干病变特点及SYNTAX评分、CABG和PCI手术情况,随访患者术后3年的主要不良心脑血管事件(MACCE)发生率以及冠脉造影复查情况.结果:①两组患者基本情况、左主干病变特点及SYNTAX评分等方面差异均无统计学意义(P>0.05),但CABG组合并三支血管病变多于PCI-DES组,差异有统计学意义[74.47%(70例)vs.41.07%(46例),P<0.01].②住院期间CABG组的MACCE发生率较PCI-DES组高(P<0.05).术后3年随访,两组的MACCE发生率及无MACCE生存率比较差异无统计学意义,但PCI-DES组靶血管再次血运重建率明显高于CABG组(P<0.05).③两组间SYNTAX评分差异无统计学意义(P>0.05).PCI-DES组中,高积分(≥30.0)患者术后3年MACCE发生率明显高于低积分(<30.0)患者(P<0.01),而术后3年无MACCE生存率低于低积分患者(P<0.01).CABG组中,高积分和低积分患者术后3年MACCE发生率及无MACCE生存率比较差异无统计学意义(P>0.05).高积分患者中,术后3年PCI-DES组MACCE发生率高于CABG组,无MACCE生存率低于CABG组(P均<0.05).低积分患者中,术后3年PCI-DES组MACCE发生率低于CABG组,无MACCE生存率PCI-DES组高于CABG组(P均<0.05),差异均有统计学意义.结论:用SYNTAX评分指导无保护左主干病变的血管重建方式选择有重要价值,但在不同的患者中,仍应结合临床特征和冠脉病变特点选择恰当的血运重建术.