完全血运重建对DES治疗三支病变患者疗效的评估

Effects of complete and incomplete revascularization in severe coronary heart disease patients with three-vessel disease after drug-eluting stent implantation

目的:探讨是否完全血运重建对接受药物洗脱支架(DES)治疗的冠心病三支病变患者临床疗效的分析。评价SYNTAX评分对三支病变患者治疗策略的指导意义。方法:分析行DES植入治疗的118例三支病变患者,进行SYNTAX评分。根据是否完全血运重建分为两组。对两组患者术后3年的死亡、再次心绞痛复发、非致命性心肌梗死、非致死性脑卒中和再次血运重建事件进行随访,并综合SYNTAX评分进行分析。结果:两组间各种心脑血管不良事件(MACCE)无统计学差异,但再次心绞痛复发、再次血运重建两类事件在非完全血运重建组有增高趋势,至非完全血运重建组总体MACCE发生率高于完全血运重建组,具有统计学差异(37%vs.12%,P<0.05)。非完全血运重建组较完全血运重建组总体MACCE发生率在SYNTAX评分高计分、中低计分患者中均表现出增高趋势,且高计分患者更明显,但差异均未达到显著水平。结论:接受DES植入治疗的三支病变患者完全血运重建效果好于非完全血运重建,SYNTAX高计分患者更明显。

AIM ： To investigate the clinical effects of complete and incomplete revascularization in severe coronary heart disease （CHD） patients with three-vessel disease after drug-eluting stent （DES） implantation and to assess the significance of SYNTAX score in the treatment strategy for patients with three-vessel disease. METHODS： Included in this retrospective study were 118 consecutive CHD patients with threevessel disease who had undergone successful DES implantation. Patients were divided into two groups： complete revaseularization group and incomplete revascularization group. The occurrence of adverse events such as death, recurrence of angina, nonfatal myocardial infarction, nonfatal stroke and revascularization was followed up for 3 years after DES implantation and was analyzed with SYNTAX score. RESULTS： No significant difference was found in the incidence of MACCE adverse events including death, recurrence of angina, nonfatal myocardial infarction, nonfatal stroke and revascularization between groups but the total incidence of MACCE adverse events was significantly higher in the incomplete revascu- larization group compared with that in the complete revascularization group （ 19. 4% vs. 8. 9%, P 〈 0. 05 ）. Compared with that in the complete revascularization group, a more increased tendency in the incidence of MACCE adverse events was found in the high and moderate scoring subgroups of SYNTAX score, more marked in the high score subgroup in the incomplete revascularization group. CONCLUSION： Effects of complete revascularization are much better than those of incomplete revascularization in CHD patients with three-vessel disease ＇after DES implantation, especially in patients with high SYNTAX score.