SYNTAX评分中分区冠心病患者再血管化治疗的选择及预后的影响因素

Choice for revascularization treatment and influencing factors for prognosis in coronary artery disease patients with moderate SYNTAX score

目的探讨SYNTAX评分中分区冠心病患者再血管化治疗的选择及预后的影响因素。方法选取SYNTAX评分中分区的冠心病患者120例,根据治疗方法分为经皮冠状动脉介入(PCI)组64例和冠状动脉旁路移植术(CABG)组56例。比较两组患者的临床特征及术后随访12个月期间的主要不良心脑血管事件(MACCE),分析MACCE发生的影响因素。结果与CABG组比较,PCI组术前左主干病变率、SYNTAX评分及术后完全血运重建率均更低,CRUSADE出血风险评分更高,住院时间及住院费用均更少(均P <0. 05)。两组患者随访期间的MACCE发生率差异无统计学意义(P> 0. 05)。多因素分析显示,左主干病变及全球急性冠状动脉事件注册(GRACE)评分高危均为MACCE的独立危险因素(P <0. 05)。结论对于SYNTAX评分为中分区的冠心病患者,可根据SYNTAX评分、CRUSADE出血风险评分以及左主干病变发生情况选择治疗方法,合并左主干病变及GRACE评分高危均为行PCI或CABG治疗后12个月MACCE的独立危险因素。

Objective To investigate the choice for revascularization treatment and the influencing factors for prognosis in the coronary artery disease(CHD)patients with moderate SYNTAX score.Methods A total of 120 CHD patients with moderate SYNTAX score were selected,then divided into percutaneous coronary intervention(PCI)group(n=64)or coronary artery bypass grafting(CABG)group(n=56)according to their therapeutic method.Clinical features and the major adverse cardiovascular and cerebrovascular events(MACCE)during the postoperative 12-month follow-up were compared between two groups,and influencing factors for MACCE were analyzed.Results Compared to the CABG group,the preoperative ratio of left main coronary disease,SYNTAX score,and total revascularization rate after operation were lower,CRUSADE bleeding risk score was higher,and the hospital stay and hospitalization cost were less in the PCI group(all P<0.05).There was no statistical significance in the incident rate of MACCE during the follow-up between the two groups(P >0.05).Multivariate analysis showed that left main coronary disease and high-risk of global registry of acute coronary events(GRACE)score were independent risk factors of MACCE(all P<0.05).Conclusion For CHD patients with moderate SYNTAX score,the therapeutic method can be chosen according to the SYNTAX score,CRUSADE bleeding risk score and the occurrence of left main coronary disease,and being complicated with left main coronary disease and high-risk of GRACE score are the independent risk factors for MACCE 12 months after PCI or CABG.