SYNTAX积分与急性心肌梗死急诊介入治疗后心血管事件的关系

SYNTAX score and cardiovascular events in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

目的：探讨SYNTAX积分对急性ST段抬高型心肌梗死（STEMI）患者急诊介入治疗术后院内及1年预后的预测作用。方法：连续纳入因急性STEMI行急诊经皮冠状动脉介入治疗（PCI）的患者共312例，根据冠状动脉造影结果计算SYNTAX积分后分为3组，A组170例为基线SYNTAX积分（bSSC）〈22分；B组90例，bSSC=22～32分；C组52例，bSSC〉32分。结果：（1）B组、C组与A组比较，合并糖尿病患者的比例较高，肌酸激酶同工酶（CK—MB）、尿酸（UA）及空腹血糖水平较高，差异有统计学意义，P〈0．05。（2）A、B、C3组患者院内严重不良心血管事件发生的比例分别是6．6％（n=11）、31．1％（n=28）、36．5％（n=19），差异有统计学意义，P〈0．05。（3）入选患者平均随访（14．2±0．8）月，Kaplan—Meier生存分析显示，3组主要不良心血管事件（MACE）、全因死亡、非致死性心肌梗死、非计划再次PCI、因心力衰竭发作入院治疗的累积事件发生率有显著差异，log-rankP〈0．001。（4）多因素Cox回归分析显示，bSSC（HR=1．059，95％CI：1．035～1．083，P〈0．001）、剩余SYNTAX积分（rSSC）（HR=1．056，95％CI：1．033～1．081．P〈0．001）是STEMI患者急诊PCI术后MACE的独立预测因子。结论：院内及随访结果显示bSSC是STEMI患者急诊PCI术后MACE的独立预测因子。

Objective： To investigate the predictive effect of SYNTAX score for in-hospital and one-year prognosis outcome in patients with ST-segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. Methods：A total of 312 patients with STEMI undergoing primary PCI were divided into three groups based on SYNTAX scores which were calculated by angiography results. Group A （n=170） was defined as baseline SYNTAX score （bSSC） 〈22, group B bSSC=22-32 （n=90）, group C bSSC〉32 （n=52）. Results：（1） Group B and group C had a higher proportion of patients with diabetes, a higher CK-MB, UA, fasting glucose compared with group A （P〈0.05）. （2） The proportions of patients with severe adverse cardiovascular events in-hospital in three groups were 6.6% （n= 11）, 31.1% （n=28）, 36.5% （n=19） respectively （P〈0.05）. （3） For patients whose follow-up periods were （14.2±0.8） months, Kaplan-Meier survival analysis showed log-rank P〈0.O01 was found among major adverse cardiovascular events （MACE）, all-cause death, non-fatal MI, unplanned revascularization for ischemia, rehospitalization due to heart failure. （4） By muhivariable analysis, bSSC and rSSC were found to be significant independent predictor for all ischemie outcomes at year 1, including MACE （HR=l.059, 95%CI： 1.035-1.083, P〈0.001; HR= 1.056, 95%CI： 1.033-1.081, P〈0.001）. Conclusion：The SYNTAX score is an independent predictor for in-hospital as well as long-term mortality and MACE in patients with acute STEMI undergoing primary PCI.