采用冠状动脉造影和临床特征评分系统对无保护左主干支架术老年患者预后的预测

Prognostic value by combination of angiographic and clinical characteristics in stented patients with unprotected left main coronary artery lesion

目的比较联用冠状动脉造影和临床特征的整体风险分层系统（ Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery, SYNTAX）评分和临床特征欧洲心脏手术危险评估系统（The European System for Cardiac Operative Risk Evaluation, EuroSCORE）在无保护左主干（ULMCA）病变老年人支架置入术后的预测价值。方法老年ULMCA病变接受支架术治疗105例，根据有无主要不良心脏事件（MACE）分两组，分析GRC评分与SYNTAX积分和EuroSCORE评估方法对MACE的预测价值。结果EuroSCORE评分MACE组与非MACE组分别为（2．0±2．3）分和（6．5±2．9）分（t=8．18，P=0．002）；左主干伴3支病变和左主干分叉病变的比例高（z。值分别为8．96、6．96，P值为0．011和0．008）；MACE发生率GRC高危组55．9％（19／34），较中危组20．5％（9／44）和低危组7．4％（2／27）高（Х^2=19．77，P=0．001）。GRC对MACE的预测价值优于SYNTAX积分和EuroSCORE积分，GRC、SYNTAX积分及EuroSCORE的曲线下面积〈95％cJ分别为0．821（0．730～0．912）、0．586（0．462～0．709）和0．631（0506～0．757）]，GRC与SYNTAX积分和EuroSCORE比较，差异有统计学意义（Z值分别为3．29、2．63，P〈0．01、P〈0．05）。结论GRC评分较SYNTAX积分和EuroSCORE更好的预测ULMCA病变老年患者的MACE。

Objective To compare the predicting values for Prognosis among Global Risk Classification （GRS）, Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery （SYNTAX） score, the European System for Cardiac Operative Risk Evaluation （EuroSCORE） in patients who received stenting because of unprotected left main coronary artery （ULMCA） lesion. Methods Totally 105 successive elderly patients with ULMCA lesion who received stenting were divided into 2 groups： with and without main adverse cardiac events （MACE）. The clinical and angiographic characteristics were analyzed and then compared among GRC, SYNTAX score and EuroSCORE. Results As compared with none MACE group, MACE group had higher EuroSCORE score （2.0±2.3 vs. 6.5±2.9, t=8.18,P=0. 002）, and more trivessel disease and left main bifurcation lesion （Z2 = 8.96, 6.96, P = 0. 011, P = 0. 008）. High risk GRC showed more MACE than medium or low risk GRC [55.9% （19/34） vs. 20.5%（9/44）, 7.4%（2/27）, ）%2 =19.77, P=0.001]. AUC（95%CI ）of GRC, SYNTAX score and EuroSCORE were CO. 821（0. 730-0. 912）, 0. 586（0. 462-0. 709） and 0. 631 （0506-0. 757）], respectively. Compared with SYNTAX score and EuroSCORE, GRC was superior in the MACE predicting value （Z=3.29, 2.63, P〈0.01 or P〈 0.05）. Conclusions Compared with SYNTAX score and EuroSCORE, GRC provides better predicting value in terms of MACE for elderly patients with ULMCA lesion receiving stenting.