SYNTAX积分对冠心病经皮冠状动脉介入治疗效果的预测

The value of SYNTAX score in predicting outcome patients undergoing percutaneous coronaryintervention

目的研究SYNTAX积分对复杂冠心病患者经皮冠状动脉（冠脉）介入治疗术（PCI）效果预测作用。方法回顾性分析PCI置入雷帕霉素药物洗脱支架左主干／3支病变的冠心病患者共190例，计算SYNTAX积分及临床SYNTAX积分，随访其主要不良心脑血管事件（MACCE），包括死亡、非致命性心肌梗死、再次血运重建、脑血管事件发生率。分别评价SYNTAX积分及临床SYNTAX积分对PCI效果的预测作用。结果SYNTAX积分低、中及高分组的MACCE率分别为9．1％、16．2％及30．9％。临床SYNTAX评分低、中及高分组的MACCE率分别为14．9％、9．8％及30．6％，单因素及多因素分析结果均显示SYNTAX积分及临床SYNTAX积分是MACCE的独立预测因子。ROC曲线分析结果SYNTAX积分AUC（0．667）大于临床SYNTAX积分AUC（0．636）。结论SYNTAX积分及临床SYNTAX积分对冠脉左主干／3支病变患者行PCI治疗后是否发生MACCE均有预测作用，在这一组人群中临床SYNTAX积分不优于SYNTAX积分。

Objective To assess the value of SYNTAX score to predict major adverse cardiac and cerebrovascular events （MACCE） among patients with three-vessel or left-main coronary artery disease undergoing percutaneous coronary intervention. Methods 190 patients with three-vessel or left-main coronary artery disease undergoing percutaneous coronary intervention （PCI） with Cypher select drug-eluting stent were enrolled. SYNTAX score and clinical SYNTAX score were retrospectively calculated. Our clinical Endpoint focused on MACCE, a composite of death, nonfatal myocardial infarction （MI） , stroke and repeat revaseularization. The value of SYNTAX score and clinical SYNTAX score to predict MACCE were studied respectively. Results 29 patients were observed to suffer from MACCE, accouting 18.5% of the overall 190 patients. MACCE rates of low （ ≤20. 5 ）, intermediate （ 21.0-31.0 ）, and high （ ≥31.5 ） tertiles according to SYNTAX score were 9. 1% , 16. 2% and 30. 9% respectively. Both univariate and multivariate analysis showed that SYNTAX score was the independent predictor of MACCE. MACCE rates of low （ ≤19. 5）, intermediate（ 19.6-29. 1 ）, and high（≥29.2） tertiles according to clinical SYNTAX score were 14. 9%, 9.8% and 30. 6% respectively. Both univariate and multivariate analysis showed that clinical SYNTAX score was the independent predictor of MACCE. ROC analysis showed both SYNTAX score （ AUC = 0. 667, P = 0. 004 ） and clinical SYNTAX score （ AUC = 0. 636, P = 0. 020 ） had predictive value of MACCE. Clinical SYNTAX score failed to show better predictive ability than the SYNTAX score. Conclusions Both SYNTAX score and clinical SYNTAX score could be independent risk predictors for MACCE among patients with three-vessel or left-main coronary artery disease undergoing percutaneous coronary intervention. Clinical SYNTAX score failed to show better predictive ability than the SYNTAX score in this group of patients.