急性ST段抬高型心肌梗死急诊PCI时Syntax评分对预后危险分层的作用探讨

The association between emergency percutaneous coronary intervention- based Syntax scores and long-term cardiovascular outcomes in patients with ST-elevation myocardial infarction

【目的】探讨急诊经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）时Syntax评分对急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者预后危险分层的影响。【方法】连续纳入接受急诊PCI治疗的STEMI患者,对患者进行为期2年的随访,观察心血管死亡、非致命的缺血性脑卒中、再发心肌梗死、需要急诊或者择期再次血运重建和心力衰竭再次入院等心血管不良事件（major adverse cardiovascular events,MACE）发生情况;采用Cox比例风险回归模型分析急诊PCI时Syntax评分与MACE发生的关系。【结果】自2012年11月至2013年5月期间共纳入STEMI患者100例,其中男性78例,女性22例,平均年龄59.54岁;随访2年共有28例首发MACE出现。受试者工作特征（receiver operating characteristic,ROC）曲线分析显示,Syntax评分（曲线下面积：0.642,95%可信区间：0.540-0.736,P=0.015）对首发MACE具有预测价值,且由约登指数计算得最佳截断值为18.5。Kaplan-Meier生存曲线分析显示,Syntax评分〉18.5时MACE发生明显高于SNYTAX评分≤18.5（P=0.009）。Cox回归单因素分析Syntax评分（〉18.5）及梗死部位是对急诊PCI术后远期发生MACE有显著性影响的因素。校正年龄和性别后,Syntax评分（〉18.5）仍是MACE发生的独立危险因素（HR：2.434,95%CI：1.084-5.465,P=0.031）。【结论】本研究初步证实,急诊PCI时冠脉Syntax评分较高者（〉18.5）STEMI后不良心血管事件增加。

【Objective】To investigate the association between the prognostic role of emergency percutaneous coronary interventionbased Syntax scores and long- term adverse cardiovascular events in patients following de novo ST- elevation myocardial infarction【Methods】Consecutive patients with STEMI undergoing PCI treatment were followed up for the occurrence of first major adverse cardiovascular events（MACE, defined as cardiovascular death, non-fatal ischemic stroke, recurrent MI, need for emergency or elective repeat revascularization, and re-hospitalization for heart failure）. The association between Syntax scores and post-STEMI MACE was analyzed using Cox proportional hazards survival model.【Results】A total of 100 cases of STEMI patients were enrolled during November 2012 to May 2013, among which 78 were male and 22 were female with the average age of 59.54 ± 11.41. Twenty- eight MACE were recorded during follow- up. Receiver operating characteristic curve analysis indicated that Syntax score（AUC：0.642, 95% CI： 0.540-0.736, P=0.015） had predictive value for MACE. The best cutoff Value of 18.5 was calculated based on Youden index. The Kaplan-Meier survival curve analysis showed that, in patients with Syntax score 18.5 group, MACE incidence was higher than Those with syntax score ≤18.5 group（P= 0.009）. Univariate and multivariate-adjusted Cox regression model showed that increased Syntax score（18.5） was independently associated with higher incidence of MACE（HR： 2.434, 95%CI： 1.084-5.465, P=0.031）.【Conclusion】Our data confirms that emergency PCI-based Syntax score measurement could provide prognostic value for patients following STEMI.