残余SYNTAX积分与冠心病患者经皮冠状动脉介入治疗术后运动耐量的关系

Relationship Between the Residual SYNTAX Score and Exercise Tolerance in Patients With Coronary Atherosclerotic Heart Disease Undergoing Percutaneous Coronary Intervention

目的:探讨通过残余SYNTAX积分(rSS)反映的不同血运重建程度的冠心病患者行经皮冠状动脉介入治疗(PCI)术后运动耐量的差异。方法:连续入选2011年1月至2018年1月通过冠状动脉造影明确诊断冠心病并行PCI,并在PCI后12个月之内完成心肺运动试验(CPET)的患者共95例。通过两种方式将患者分组:(1)依据r SS将患者进行分组,分为rSS=0分组(n=27), 0分<rSS≤8分组(n=40),rSS>8分组(n=28);(2)依据基础SYNTAX积分(bSS)将患者分组,由于所有患者的bSS均不超过32,故根据bSS将所有患者分为bSS≤22分组(n=70)和bSS>22分组(n=25)。比较不同组患者1年内CPET参数,包括反映运动耐量的峰值代谢当量(MET_(peak))、峰值代谢当量占预计值百分比(MET_(peak)%pred)、峰值耗氧量(VO_(2peak))、峰值耗氧量占预计值百分比(VO_(2peak)%pred)、无氧阈(AT)时VO_2等指标,反映通气功能的每分通气量(VE)、二氧化碳通气当量(VE/VCO2)等指标。结果:rSS分组中,rSS=0分、 0分<rSS≤8分和rSS>8分三组患者反映运动耐量的MET_(peak)[(7.39±1.81) mets vs (6.96±1.66) mets vs (5.94±1.34) mets,P=0.005]、MET_(peak)%pred[(88.96±16.44)%vs (81.31±19.05)%vs(70.77±15.07)%,P=0.001]、AT时MET[(4.77±0.99)mets vs (4.73±0.96) mets vs (4.06±1.12) mets,P=0.018]、VO_(2peak)%pred[(83.27±16.24)%vs (80.71±16.57)%vs (72.77±12.71)%,P=0.040]、AT时VO_2[(16.72±3.48)ml/(min·kg) vs (16.58±3.34) ml/(min·kg) vs (14.36±3.87) ml/(min·kg),P=0.028],差异均有统计学意义;将三组间差异有统计学意义的参数三组进行LSD-t检验多重比较时,rSS=0分组和0分<rSS≤8分组之间差异均无统计学意义,而此两组的MET_(peak)、MET_(peak)%pred、AT时VO_2、AT时MET和rSS>8分组比较差异均有统计学意义(P<0.05)。根据bSS分组中,bSS≤22分组和bSS>22分组患者的CPET相关参数差异均无统计学意义。结论:(1)接受PCI的患者,完全血运重建(rSS=0分组)患者与合理的不完全血运重建(0分<rSS≤8分组)患者运动耐量差异无统计学意义,而此两组患者的运动耐量均优于残余冠状动脉病变负荷仍较重(rSS>8分组)的患者;(2)与bSS相比,rSS可更好地评价患者的运动耐量。

Objectives:The purpose of this study was to quantify the level of incomplete revascularization post percutaneous coronary intervention(PCI)by the residual SYNTAX score(rSS)and evaluate the association between rSS and exercise tolerance post PCI in patients with coronary atherosclerotic heart disease(CAD).Methods:We enrolled 95 CAD patients treated with PCI and completed CPET within 12 months after PCI treatment.The patients were divided into different subgroups according to residual SYNTAX score or baseline SYNTAX score(bSS):(1)according to residual SYNTAX score,patients were divided into rSS=0 group(n=27),0<rSS≤8 group(n=40),and rSS>8 group(n=28);(2)according to baseline SYNTAX score,patients were divided into low bSS group(bSS≤22,n=70)and moderate bSS group(bSS>22,n=25).The CPET variables within 1 year,including METpeak,METpeak%pred,MET at anaerobic threshold(AT),VO2 peak,VO2 peak%pred,VO2 at AT,were collected and compared.Results:Among rSS=0,0<rSS≤8 and rSS>8 groups,there were statistical differences in METpeak([7.39±1.81]mets vs[6.96±1.66]mets vs[5.94±1.34]mets,P=0.005),METpeak%pred([88.96±16.44]%vs[81.31±19.05]%vs[70.77±15.07]%,P=0.001),MET at AT([4.77±0.99]mets vs[4.73±0.96]mets vs[4.06±1.12]mets,P=0.018),VO2 peak%pred([83.27±16.24]%vs[80.71±16.57]%vs[72.77±12.71]%,P=0.040),VO2 at AT([16.72±3.48]ml/(min?kg)vs[16.58±3.34]ml/(min?kg)vs[14.36±3.87]ml/(min?kg),P=0.028).There was no statistical difference in CPET variables between bSS≤22 group and bSS>22 group.Conclusions:(1)There is no significant difference in exercise tolerance between CR(rSS=0)and rICR(0<rSS≤8)groups in CAD patients treated by PCI.However,the exercise tolerance of CR and rICR groups is better than patients with heavy residual lesion of coronary artery(rSS>8);(2)Residual SYNTAX score is superior to baseline SYNTAX score on reflecting exercise tolerance in CAD patients post PCI.