残余SYNTAX评分在中国冠心病介入患者中的应用价值研究

Application Value of Residual SYNTAX Score in Coronary Artery Disease Patients With Percutaneous Coronary Intervention in China

目的:经皮冠状动脉介入治疗(PCI)术后残余SYNTAX评分(rSS)可作为临床预后的独立预测因子,也可作为不完全血运重建的量化工具。本研究旨在评估在大样本中国冠心病介入患者中rSS对预后的评估价值。方法:纳入我院2013年度共10 724例PCI患者,排除既往行冠状动脉旁路移植术(CABG)以及本次支架置入术为杂交手术的患者381例,最终纳入10 343例冠心病患者。PCI术前分别计算基线SYNTAX评分(b SS)和rSS。rSS=0定义为完全血运重建,rSS≥1定义为不完全血运重建。临床随访30个月,临床终点事件包括主要不良心血管事件(MACE,全因死亡、心肌梗死和再次血运重建的复合终点)、全因死亡、心原性死亡、心肌梗死、全因死亡/心肌梗死和再次血运重建。结果:PCI术后共有5 050例(48.8%)患者达到完全血运重建(rSS=0)。5 293例不完全血运重建(rSS≥1)的患者中,1≤rSS≤4的患者有1 908例(18.4%),4<rSS≤9的患者有1 777例(17.2%),rSS>9的患者有1 608例(15.5%)。rSS评分越高的患者合并的临床情况越多,冠状动脉病变越复杂。与完全血运重建相比,不完全血运重建患者的30个月临床终点事件发生率更高,并且随着rSS评分增高,临床终点事件发生率亦增高。通过多因素回归分析,rSS是所有不良终点事件的独立预测因素。结论:不完全血运重建的患者,尤其是rSS>9的患者,30个月的临床终点事件率更高,预后更差。rSS是临床预后的独立预测因素。对于中国的PCI患者,rSS是一个很好的量化血运重建程度以及评估预后的工具。

Objective： Residual SYNTAX score（r SS） can be used as the independent predictor for clinical prognosis and the tool for quantifying incomplete revascularization（IR） in coronary artery disease（CAD） patients with percutaneous coronary intervention（PCI）. Our work assessed the prognostic value of r SS on large-scale PCI patients in China.Methods： A total of 10 724 CAD patients undergoing PCI in our hospital in 2013 were studied; 381 patients with previous CABG and hybrid procedure were excluded, 10 343 patients were finally enrolled. Baseline SYNTAX score（b SS） and r SS were calculated before and after PCI. Complete revascularization（CR） was defined by r SS=0 and IR was defined by r SS≥1. The patients were followed-up for 30 months. Clinical endpoint events included MACE, a composite event of allcause death, myocardial infarction（MI） and revascularization; all-cause death, cardiac death, MI, all-cause death/MI and revascularization. Results： There were 5 050/10 343（48.8%） patients having CR and 5 293 having IR including 1 908（18.4%） patients with 1≤r SS≤4, 1 777（17.2%） with 4r SS≤9 and 1608（15.5%） with r SS〉9. Patients with the higher r SS had more clinical comorbidity and more complicated coronary lesions. Compared with CR patients, IR patients had the higher incidences of 30-month clinical endpoint events. As r SS increasing, the incidence of MACE was elevating accordingly. Multivariate regression analysis indicated that r SS was the independent predictor for MACE and all other endpoints occurrence.Conclusion： IR patients especially those with r SS〉9 had the higher incidence of adverse clinical outcomes. r SS has been a good tool for quantifying revascularization and assessing prognosis in PCI patients in China.