多支冠脉病变不完全血运重建的远期预后

Long-term prognosis of incomplete revascularisation for multivessel coronary artery disease

目的以残余SYNTAX积分(rSS)定量评价不完全血运重建,探讨其对多支病变患者行经皮冠脉介入(PCI)治疗的远期预后评价。方法入选2010年1月至2011年6月在天津胸科医院经冠状动脉造影证实为多支病变并行PCI治疗患者653例。根据PCI术前和术后冠状动脉造影结果计算SYNTAX积分和残余SYNTAX积分。根据rSS分为:rSS≤4(207例);4<rSS≤8(224例);rSS>8(177例)。随访3~4年终点事件发生率。结果 653例患者中失访104例,与rSS≤4组和4<rSS≤8组比较,rSS>8组MACCE发生率(x^2=15.347,P<0.05)、心原性死亡率(x^2=7.383,P<0.05)、再次血运重建率(x^2=6.485,P<0.05)均明显升高,全因死亡率也明显增高(x^2=7.742,P<0.05)。Kaplan-Meier生存分析显示,rSS>8组患者长期无事件生存率明显低于rSS≤4和4<rSS≤8两组患者(x^2=7.742,P=0.012)。结论残余SYNTAX积分可定量评价不完全血运重建,是PCI术后远期预后的预测因子,并有助于再血管化的治疗策略选择。

Objective To quantitative evaluation of incomplete revascularization in patients undergoing percutaneous coronary intervention （PCI） using the residual SYNTAX score （rSS）, and to investigate the prognostic impact of this score to predict long-term survival rate post PCI. Methods From January 2010 to June 2011, 653 patients with multivessel coronary artery disease underwent PCI were enrolled in this study. The SYNTAX score （SS） and rSS were calculated before and after PCI. According to rSS the patients were defined as： rSS∪4 （n =207）, 4 〈rSS≤8 （n =224）, rSS 〉8 （n = 177）, respectively. Major adverse cardiac cerebrovaseular events （MACCE） rates （cardiac death, nonfatal myocardial infarction, revascularization and stroke） and all-cause mortality, were followed-up in 3 -4 year. Results 104 out of 653 cases were lost to follow-up. MACCE rate of rSS 〉 8 group was significantly higher than that of both rSS ≤ 4 group and 4 〈 rSS ∪ 8 group （x^2 = 15. 347, P 〈 0.05 ）. All-cause mortality at 3 - 4 year was significantly increased in rSS 〉 8 group （x^2 = 7. 742, P 〈 0. 05）. Kaplan-Meier survival curves showed the survival rate in rSS 〉 8 group was significantly lower than which in both rSS≤4 group and 4 〈 rSS ≤8 group （x^2 =7.742,P =0.012）. Conclusions The residual SYNTAX score is a useful criteria to quantitatively evaluate incomplete revascularization in patients undergoing PCI for muhivessel coronary artery disease. It is a long-term prognosis post PCI predictor and contributes to revascularization strategy selection.