SYNTAX评分、ACEF评分及衍生评分在急诊冠心病介入中对无复流的预测价值研究

Predictive Value of the SYNTAX Score,ACEF Score and Derived-scores for No-reflow in Patients Undergoing Emergency Percutaneous Coronary Intervention

目的评估在急诊经皮冠状动脉介入治疗术(PCI)中,SYNTAX评分、ACEF评分及衍生评分对无复流发生的预测价值。方法入选阜外医院2013年接受急诊PCI治疗的患者。排除PCI术前无血清肌酐和射血分数测定结果的患者,以及既往曾行冠状动脉旁路移植术的患者。最终纳入491例患者。研究终点为PCI术中是否发生无复流,定义为除外冠脉机械梗阻的前提下相关冠状动脉前向TIMI血流≤2级或MBG分级0~1级。结果入选患者中53例(10.8%)患者在急诊PCI术中发生无复流。无复流组的患者平均年龄更大、术前心功能更差、冠脉病变相对更加复杂。各个评分的高分组患者急诊PCI术中无复流的发生率显著增高(无复流发生率17.7%~20.4%,比值比2.71~3.37,P<0.01)。根据ROC曲线结果,各个评分对预测无复流有较好的区分度,曲线下面积(AUC)为0.637~0.673。Clinical SYNTAX评分的AUC值最高(AUC=0.673,95%CI:0.629~0.714),与SYNTAX评分之间有统计学差异(P<0.05)。结论一定程度上讲,SYNTAX评分、ACEF评分及衍生评分是有效预测急诊PCI术中是否无复流的评分工具。

Objective To validate the predictive value of the SYNTAX score,ACEF score,and derived scores for no-reflow in patients undergoing emergency percutaneous coronary intervention(PCI).Methods From January 2013 to December 2013,consecutive patients underwent emergency PCI in Fuwai Hospital were screened.Patients without available ejection fraction and serum creatinine values before PCI,and patients with previous coronary artery bypass grafting or received hybrid procedure were excluded.Finally,our study included 491 patients.The endpoint was no-reflow during PCI procedure,defined as TIMI flow grade≤2 or myocardial blush grade 0-1 without angiographic evidence of mechanical vessel obstruction.Results Of the patients,53(10.8%)patients experienced no-reflow during PCI procedure.Patients who had no-reflow were older,had worse cardiac function and more complicated coronary lesions.The high score groups showed significantly higher no-reflow rates during PCI(no-reflow rates 17.7%-20.4%,odds ratio:2.71-3.37,P<0.01).Based on ROC curves analysis,the scores involved showed moderate discrimination ability for no-reflow(area under curve[AUC]:0.637-0.673).Clinical SYNTAX score showed the highest AUC(AUC=0.673,95%CI:0.629-0.714),which was significantly higher than that of SYANTX score(P<0.05).Conclusion SYNTAX score,ACEF score,and derived scores are useful risk stratification tools for no-reflow in patients undergoing emergency PCI.