临床SYNTAX积分和SYNTAX积分预测复杂冠状动脉性心脏病患者经皮冠状动脉介入治疗预后的对比研究

摘要

目的 比较临床SYNTAX积分和SYNTAX积分对冠状动脉性心脏病(简称冠心病)3支病变和/或左主干病变患者经皮冠状动脉介入治疗(PCI)预后的预测作用.方法 回顾性分析2007年1月至2008年12月北京安贞医院经造影证实3支病变和/或左主干病变并接受PCI治疗的患者.对每例患者进行SYNTAX积分和临床SYNTAX积分,通过门诊或电话随访患者主要不良心脑血管事件(MACCE),包括全因死亡、非致命性心肌梗死、再次血运重建、中风等.结果 符合入选条件的患者总计190例,其中29例观察到MACCE,MACCE发生率18.5％.多因素分析结果显示,临床SYNTAX积分和SYNTAX积分均为MACCE的独立预测因子[临床SYNTAX积分,风险比(HR):2.07,95％可信区间(CI):1.25 ～3.44,P=0.005:SYNTAX积分,HR:1.86,95％CI:1.14 ～3.06,P=0.014].受试者工作特征(ROC)曲线分析显示,SYNTAX积分曲线下面积(AUC)=0.667 (95％ CI:0.564 ～ 0.770,P=0.004),临床SYNTAX积分AUC =0.636(95％ CI:0.519 ～0.753,P=0.020),两者均对MACCE有预测价值,加入了年龄肌酐射血分数(ACEF)积分的临床SYNTAX积分未能提高SYNTAX积分对MACCE的预测能力.结论 临床SYNTAX积分和SYNTAX积分均是预测复杂冠心病患者PCI预后的较理想工具,且临床SYNTAX积分并不优于SYNTAX积分.%Objective To compare the value of clinical SYNTAX score and SYNTAX score on predicting the prognosis of coronary heart disease (CHD) patients with left main and/or three vessel lesion undergoing percutaneous coronary intervention PCI) . Methods The data of CHD patients with left main and/or three vessel lesign undergoing PCI in Anzhen Hospital from January 2007 to December 2008 were retrospectively analyzed. Each patient was evaluated with clinical SYNTAX score and SYNTAX score. The major adverse cardiac and cerebrovascular events ( MACCE) were follower up by telephone or at outpatient department, including all-cause mortality, nonfatal myocardial infarction, target lesion revascularization and stroke. Results One hundred and ninety patients were enrolled in this study,among whom MACCE happened in 29 patients. MACCE rate was 18.5%. Clinical SYNTAX score and SYNTAX score were identified as independent predictors of MACCE [ clinical SYNTAX score,hazard ratio(HR) :2.07,95% confidence interval(CI):1. 25 -3. 44,P =0. 005 ;SYNTAX score,HR: 1. 86, 95%CI;1. 14 - 3. 06, P =0.014] in multivariate analysis. Receiver operating characteristics curve (ROC) analysis showed both SYNTAX score[ area under curve (AUC) = 0. 667,95% CI: 0. 564 - 0. 770, P = 0. 004 ] and clinical SYNTAX score ( AUC =0.636,95% CI:0.519 -0. 753 ,P =0. 020) had predictive value of MACCE in CHD patients with three-vessel and/or left-main undergoing PCI. When ACEF(age,creatinine,ejection fraction) score was fitted to the SYNTAX score model,clinical SYNTAX score failed to show better predictive value than the SYNTAX score. Conclusion Clinical SYNTAX score and SYNTAX score are ideal methods to predict the prognosis of CHD patients undergoing PCI. Clinical SYNTAX score is no better than SYNTAX score to predict the prognosis of patients undergoing PCI.