不同冠心病危险评分评估ACS患者多支血管病变PCI术后2年预后的比较

Evaluation to prognosis by different methods of coronary heart disease risk score in patients with acute coronary syndrome and muitivessels lesions and referred for percutaneous coronary intervention after two years

目的评价不同冠心病危险评分方法对急性冠脉综合征(ACS)患者多支病变经皮冠状动脉介入(PCI)治疗术后长期预后评价能力。方法连续入选住院ACS并行PCI患者192例,收集临床资料包括性别、年龄、临床诊断、心脏及周围血管超声、血脂、肾功能等临床资料,进行SYNTAX、SYNTAX Ⅱ、临床SYNTAX、EuroScore Ⅱ评分、ESRS危险分层,同时进行2年临床随访,随访主要不良心脑血管事件(MACCE,包括全因死亡、卒中、冠脉血运重建、心力衰竭、心绞痛住院治疗)。结果发生MACCE 24例,其中心源性死亡5例,卒中死亡2例,血运重建7例,缺血性卒中6例,心衰4例。MACCE组和无事件组的SYNTAX评分、SYNTAX Ⅱ评分、临床SYNTAX和EuroScore Ⅱ评分分别为(18±6)与(15±7)分(P<0.05)、(29±5)与(27±8)分(P<0.05)、(41±16)与(36±22)分(P<0.05)、(4.0±3.6)与(2.7±2.1)分(P<0.05)。ESRS高危、低危组事件发生率分别为29%和21%,与无事件组比较,P<0.05。SYNTAX评分、SYNTAX Ⅱ评分、临床SYNTAX评分、EuroScore Ⅱ评分和ESRS预测2年终点事件的曲线下面积分别为0.631、0.631、0.630、0.634和0.656(均P<0.05)。5种评分方法危险分层均与2年MACCE相关。结论 SYNTAX评分、SYNTAX Ⅱ评分、临床SYNTAX评分、EuroScore2以及ESRS危险分层对ACS行PCI后MACCE的预测能力无显著差异。

AIM To evaluate the ability of different scoring methods for long-term prognosis of patients with muhivessel disease after PCI. METHODS 192 consecutive patients with ACS undergoing PCI at the department of Cardiology of the Inner Mongolia Autonomous Region people＇ s Hospital were studied from January 2013 to May 2014. Among the clinical data collected included gender, age, clinical diagnosis, doppler echocardiography, peripheral vascular ultrasound, blood lipids, and renal function. SYNTAX Score, SYNTAX Score II, clinical SYNTAX Score, EuroScore2, and ESRS with 2 years clinical follow-up at the same time were measured. Follow-up measurements included main adverse cardiovascular and cerebrovascular events （MACCE） including all-cause death, stroke, coronary reascularization, heart failure, and hospitalization for angina pectoris. RESULTS There were 24 cases of MACCE in 192 patients with ACS, including cardiac death in 7 cases, stroke death in 2 cases, revascularization in 7 cases, ischemic stroke in 6 cases, heart failure in 4 cases. The SYNTAX score, SYNTAX score II, clinical SYNTAX score andEuroScore2 score were 18±6vs. 15±7 （P〈0.05）, 29±5 vs. 27±8 （P〈0.05）, 41±16vs. 36±22 （ P 〈 0.05 ）, 4.0 ± 3.6 vs. 2.7 ± 2. 1 （ P 〈 0.05 ） in event group and non event groups, respectively. The rate of MACCE with ESRS in the high-risk, and low-risk groups were 29% , 21% , P 〈 0. 05, respectively. The area under the eurve for predicting the 2 years endpoint events of SYNTAX score, SYNTAX score II, clinical SYNTAX score, EuroScore2 score and ESRS, respectively were 0. 631, 0. 631,0. 630, 0. 634, 0. 656 （all P 〈0. 05）. High-risk patients in risk stratifieation were relative to MACCE regardless of which kind of scoring methods were evaluated. CONCLUSION The SYNTAX score, SYNTAX score II, clinical SYNTAX score, EuroSeore2 and ESRS utilized to predict MACCE had no significant difference.