SYNTAX score Ⅱ积分在急性心肌梗死患者急诊直接PCI中的应用价值

目的：分析SYNTAXscoreⅡ积分在急性心肌梗死患者急诊直接PCI中的应用价值。方法：选取2011年11月～2014年9月本院收治的240例急性心肌梗死急诊直接PCI患者为研究对象，将其根据SYNTAXscore1I积分分为A组（〈21分组）80例、B组（21～31分组）80例及C组（〉31分组）80例，比较3组无复流发生率、不良心脑血管事件发生率、预后相关血清指标及血小板活化指标。结果：A组无复流发生率、不良心脑血管事件发生率、预后相关血清指标及血小板活化指标均低于B组及C组（P均〈0．05），B组低于C组（P均〈0．05），且3组中单支及多支病变患者的上述检测结果间均存在明显差异（P均〈0．05）。结论：SYNTAXscoreⅡ积分在急性心肌梗死患者急诊直接PCI中的应用价值较高，因此本积分标准在此类患者中具有积极的临床应用意义。

Value of GRACE and SYNTAX scores for predicting the prognosis of patients with non-ST elevation acute coronary syndrome

BACKGROUND GRACE and SYNTAX scores are important tools to assess prognosis in non-STelevation acute coronary syndrome(NSTE-ACS).However,there have been few studies on their value in patients receiving different types of therapies.AIM To explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies.METHODS The data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups.A total of 195 patients who received agents alone comprised the medication group,156 who received medical therapy combined with stents comprised the stent group,and 35 patients who were given agents and underwent coronary artery bypass grafting(CABG)comprised the CABG group.General information was compared among the three groups.GRACE and SYNTAX scores were calculated.The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events(MACEs)was analyzed.Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS.Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model.RESULTS The incidence of MACE increased with the elevation of GRACE and SYNTAX scores(all P<0.05).The incidence of MACE was 18.5%,36.5%,and 42.9%in the medication group,stent group,and CABG group,respectively.By comparison,the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups(all P<0.05).The incidence of MACE was 6.2%,28.0%and 40.0%in patients with a low GRACE score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 31.0%,30.3%and 42.9%in patients with a medium GRACE score in the medication group,stent group,and CABG group,respectively(P>0.05).The incidence of MACE was 16.9%,46.2%,and 43.8%in patients with a high GRACE score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 16.2%,35.4%and 60.0%in patients with a low SYNTAX score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 37.5%,40.9%,and 41.7%in patients with a medium SYNTAX score in the medication group,stent group,and CABG group,respectively(P>0.05).MACE incidence was 50.0%,75.0%,and 25.0%in patients with a high SYNTAX score in the medication group,stent group,and CABG group,respectively(P<0.05).Univariate Cox regression analyses showed that both GRACE score(hazard ratio[HR]=1.212,95%confidence interval[CI]:1.083 to 1.176;P<0.05)and SYNTAX score(HR=1.160,95%CI:1.104 to 1.192;P<0.05)were factors influencing MACE(all P<0.05).Multivariate Cox regression analyses showed that GRACE(HR=1.091,95%CI:1.015 to 1.037;P<0.05)and SYNTAX scores(HR=1.031,95%CI:1.076 to 1.143;P<0.05)were independent predictors of MACE(all P<0.05).CONCLUSION GRACE and SYNTAX scores are of great value for evaluating the prognosis of NSTE-ACS patients,and prevention and early intervention strategies should be used in clinical practice targeting different risk scores.

绝经后女性高敏C反应蛋白与冠状动脉Syntax Score相关性分析

目的:探讨绝经后女性高敏C反应蛋白(hs CRP)与冠状动脉Syntax Score(SS)相关性。方法:入组2014年12月至2016年7月在汕头市中心医院行冠状动脉造影绝经后女性260例,根据造影结果进行SS评分和分组:对照组(冠状动脉血管正常);低危组(0<SS≤22);中危组(22<SS≤32);高危组(SS>32)。比较四组hs CRP水平,对hs CRP与SS进行相关和回归分析。结果:低、中、高危组hs CRP高于对照组(P<0.001),低危组hs CRP低于中、高危组(P<0.001)。hs CRP与SS的Spearman相关系数r=0.469(P<0.001);校正年龄、高血压、糖尿病、吸烟、低密度脂蛋白胆固醇、总胆固醇因素,hs CRP与SS相关系数r=0.337(P<0.001)。hs CRP与SS单因素线性回归分析回归系数R2=0.162(P<0.001),提示hs CRP与SS呈正相关关系。多分类Logistic回归分析:低危组、中危组、高危组hs CRP水平升高(OR_(低危):4.044,OR_(中危):11.529,OR_(高危):8.550),联合高龄(>70岁)(OR_(低危):9.696,OR_(中危):35.980,OR_(高危):20.108)、糖尿病病史(OR_(低危):2.329,OR_(中危):4.502,OR_(高危):7.130)可预测SS,有统计学意义(Phs CRP<0.05,Page<0.05,PDM<0.05)。结论:绝经后女性hs CRP与冠状动脉SS呈正相关,hs CRP升高联合高龄、糖尿病可预测绝经后女性冠状动脉SS严重程度,预测绝经后女性冠心病患者冠状动脉病变程度。

Correlation between SYNTAX Score and Pattern of Risk Factors in Patients Referred for Coronary Angiography in Cardiology Department, Menoufia University

Objectives: The role of SYNTAX (SX) score in assessing the complexity of coronary artery disease (CAD) is well established. In this study we investigate the relationship between conventional risk factors of CAD with its complexity using SX score. Methods: The study consisted of 52 patients with CAD who were admitted to Cardiology Department—Menoufia University Hospitals for elective coronary angiography. The overall SX score was calculated prospectively using the SX score algorithm. Then comparison was done between populations with and without each risk factor. Results: There was a statistically significant correlation between age, hypertension, diabetes mellitus, dyslipidemia and smoking with SX score results (p 0.05). In a multivariate regression analysis, including conventional risk factors of CAD as independent covariates, it revealed that aging, having diabetes mellitus and smoking were identified as significant independent risk factors for CAD complexity. Conclusion: Advanced age, having diabetes mellitus and cigarette smoking are considered to be independent risk factors for the complexity of CAD. Therefore, when these factors present, we expect that the SX score of the patient to be high indicating a complex CAD.

Syntax score: The fallacies and remedies—A perspective

The syntax score devised as a tool to grade complexity of coronary artery disease with a view to its suitability for PCI or otherwise on deeper introspection is fraught with some inherent limitations and fallacies largely as a result of the variability in coronary anatomy and the fixed nomenclature of the devised scoring system. We, in this special report, bring out the limitations and fallacies in the same and possible remedies presented as a viewpoint which may be useful to the interventional community at large.

全身免疫炎症指数、SYNTAX评分和脂蛋白a水平对老年冠心病患者PCI术后发生支架内再狭窄的评估价值

目的探讨全身免疫炎症指数(SII)、SYNTAX评分和脂蛋白a水平对老年冠心病患者经皮冠状动脉介入(PCI)术后发生支架内再狭窄(ISR)的评估价值。方法回顾性分析504例PCI术后复查冠状动脉造影(CAG)的老年冠心病患者的临床资料。根据PCI术后1年有无发生ISR,将患者分为非ISR组(n=410)和ISR组(n=94)。比较两组患者的一般资料、实验室指标、SII及SYNTAX评分。采用多因素Logistic回归模型分析老年冠心病患者PCI术后发生ISR的影响因素,绘制受试者工作特征(ROC)曲线分析SII、SYNTAX评分和脂蛋白a水平对老年冠心病患者PCI术后发生ISR的评估价值。结果共有94例患者发生ISR,发生率为18.7%。与非ISR组相比,ISR组患者的脉压差更大,慢性肾功能不全病史比例更高,SII、SYNTAX评分、白细胞计数及总胆固醇、脂蛋白a、HbA1c、纤维蛋白酶原、肌钙蛋白I水平更高(P<0.05)。多因素Logistic回归分析结果显示,高SII、高SYNTAX评分、高脂蛋白a水平是老年冠心病患者PCI术后发生ISR的独立危险因素(P<0.05)。ROC曲线分析结果显示,SII、SYNTAX评分、脂蛋白a水平及三者联合评估老年冠心病患者PCI术后发生ISR的曲线下面积分别为0.725、0.753、0.701、0.829,且三者联合的曲线下面积大于单一指标(P<0.05)。结论高SII、高SYNTAX评分、高脂蛋白a水平是老年冠心病患者PCI术后发生ISR的独立危险因素。SII、SYNTAX评分、脂蛋白a水平对老年冠心病患者PCI术后发生ISR具有一定的评估效能,且三者联合的评估效能更佳。

高SYNTAX评分的急性心肌梗死PCI围手术期应用比伐卢定的价值分析

目的通过对高SYNTAX评分急性心肌梗死患者PCI围手术期应用比伐卢定的效益-风险分析,探讨比伐卢定在AMI患者PCI手术治疗中的使用价值。方法选择重庆三峡医药高等专科学校附属中医院2020年2月至2022年2月期间收治的141例高SYNTAX评分的AMI患者作为研究对象,根据PCI围手术期应用不同抗凝药物将患者分成两组,应用比伐卢定的68例患者纳入研究组,应用普通肝素的73例患者纳入对照组。对两组患者一般资料、心功能指标、心血管不良事件及出血事件等进行比较。建立高SYNTAX评分的AMI患者PCI围手术期应用比伐卢定的效益与风险多准则决策分析模型。利用RevMan 5.3将数据进行合并,得出各效益指标和风险指标效应值,利用Hiview 3分析研究组和对照组的风险值、效益值和效益-风险总值,并分析模型的灵敏度。结果两组患者治疗前后PLT的差异均不显著(P>0.05),研究组患者治疗后的LVESD、LVEDD、NT-proBNP、总心血管不良事件、出血及血栓均显著低于对照组(P<0.05),而治疗后的ACT、LVEF及总有效率均显著高于对照组(P<0.05);研究组和对照组的效益值分别为79、63,风险值分别为70,36,效益-风险总值分别为75,50。研究组的效益-风险总值更高。无论效益-风险的相对权重如何改变,模型评价结果均保持不变,表明该模型稳定型良好。结论对于高SYNTAX评分的AMI患者在PCI围手术期使用比伐卢定进行抗凝治疗,可获得良好的临床疗效,提升患者心功能,降低不良反应的发生,可作为普通肝素的替代药物在临床推广。

残余胆固醇水平与急性冠脉综合征患者SYNTAX评分的相关性研究

目的 探讨残余胆固醇(RC)水平与急性冠脉综合征(ACS)患者SYNTAX评分的相关性。方法 选取2022年6月至2023年4月医院收治的85例ACS患者,评估所有患者的SYNTAX评分,根据结果分为高危组(SYNTAX评分≥33分)、中危组(SYNTAX评分在23~32分)、低危组(SYNTAX评分在0~22分),设计基线资料调查表,详细统计3组患者的基线资料并比较,重点分析RC水平与ACS患者SYNTAX评分的相关性。结果 85例ACS患者经SYNTAX评分在0~22分的有43例,纳入低危组,SYNTAX评分在23~32分的有25例,纳入中危组,SYNTAX评分在33分及以上的有17例,纳入高危组;高危组患者的血清RC水平依次高于中危组、低危组(P<0.05),3组患者的吸烟史、临床表现、合并糖尿病、高密度脂蛋白胆固醇(HDL-Ch)、年龄、性别、合并高血压、总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-Ch)水平比较,无统计学差异(P>0.05);经相关性分析(Kendall's tau-b)发现,RC与ACS患者SYNTAX评分呈正相关(r>0,P<0.05)。结论 ACS患者的RC水平异常表达与SYNTAX评分密切相关,且水平过表达,提示冠脉病变严重。

Syntax score predicts clinical outcome in patients with three-vessel coronary artery disease undergoing percutaneous coronary intervention

Background The Syntax score was recently developed as a comprehensive, angiographic tool grading the complexity of coronary artery disease （CAD）. It aims to assist in patient selection and risk stratification of patients with extensive CAD undergoing revascularization. However, the prognostic value of the Syntax score in patients undergoing percutaneous coronary intervention （PCI） has not been validated. The aim of this study was to evaluate its role in predicting long-term incidences of major adverse cardiac and cerebrovascular events （MACCE） in patients undergoing PCI for 3-vessel disease.Methods Two hundred and three consecutive patients with de novo 3-vessel CAD undergoing PCI with sirolimus-eluting stents were studied. Their angiograms were scored according to the Syntax score. The patients were divided into tertiles according to the Syntax score： lowest Syntax score tertile （Syntax score 〈22）, intermediate Syntax score tertile （Syntax score of 23 to 32）, and the highest Syntax score tertile （Syntax score 〉33）. During the 1-year follow-up, the MACCE-free survival curves were estimated by the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the relation between the Syntax score and the incidence of MACCE. Performance of the Syntax score was studied with respect to predicting the rate of MACCE by receiver operator characteristic （ROC） curves with an area under the curve.Results The overall Syntax score ranged from 6 to 66 with mean ± standard deviation of 27.9±12.6 and a median of 26. At 1 year, the Syntax score significantly predicted the risk of MACCE （HR 1.07/U increase, 95% Cl 1.04 to 1.11, P 〈0.001）. The rate of MACCE was significantly increased among patients in the highest Syntax score tertile （17.9%） as compared with those with the lowest Syntax score tertile （1.4%, P 〈0.001） or intermediate Syntax score tertile （6.2%, P=0.041）. After the adjustment for all potential confounders, the Syntax score remained a significant predictor of the rate of MACCE （adjusted HR 1.12/U increase, 95% Cl 1.05 to 1.20, P 〈0.001）. The Syntax score accurately predicted MACCE with an area under the receiver operator curve of 0.77 （95% CI 0.65 to 0.90, P 〈0.001）. A Syntax score of 29.5 was identified as the optimal cutoff to predict MACCE with a sensitivity of 82.4% and specificity of 65.6%. Conclusion The Syntax score predicts the risk of MACCE in patients with 3-vessel disease undergoing PCI.

Mis-estimation of coronary lesions and rectification by SYNTAX score feedback for coronary revascularization appropriateness

Background::Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization.Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score is a comprehensive system to evaluate the complexity of the overall lesions.We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease(CAD).Methods::In this single-center,historical control study,patients with stable CAD with coronary lesion stenosis≥50%were consecutively recruited.During the control period,SYNTAX scores were calculated by treating cardiologists.During the intervention period,SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making.The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.Results::A total of 3245 patients were enrolled and assigned to the control group(08/2016-03/2017,n=1525)or the intervention group(03/2017-09/2017,n=1720).For SYNTAX score tertiles,17.9%patients were overestimated and 4.3%were underestimated by cardiologists in the control group.After adjustment,inappropriate revascularization significantly decreased in the intervention group compared with the control group(adjusted odds ratio[OR]:0.83;95%confidence interval[CI]:0.73-0.95;P=0.007).Both inappropriate percutaneous coronary intervention(adjusted OR:0.82;95%CI:0.74-0.92;P<0.001)and percutaneous coronary intervention utilization(adjusted OR:0.88;95%CI:0.79-0.98;P=0.016)decreased significantly in the intervention group.There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.Conclusions::Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.Clinical trial registration::Nos.NCT03068858 and NCT02880605;https://www.clinicaltrials.gov.

The SYNTAX score as a predictor of contrast-induced nephropathy patients with chronic total occlusion undergoing percutaneous coronary intervention

Background The SYNTAX score was developed to assess the severity and complexity of coronary artery disease and was determined to be effective in predicting contrast-induced nephropathy（CIN） in patients with STelevation myocardial infarction（STEMI） and non-STEMI（NSTEMI）. However, the relationship between SYNTAX score and CIN of patients with CTO undergoing PCI has been unclear. Methods We retrospectively enrolled 667 patients with CTO who underwent our institution′s basic PCI protocol between January 2010 and September 2012. The patients were divided into 3 groups： a low-risk group（SYNTAX score 〈 23; n = 231）, a moderate-risk group（SYNTAX score = 23-32; n = 214）, and a high-risk group（SYNTAX score〉32; n = 222）. CIN was defined as an absolute increase in SCr of ≥ 0.5 mg/d L over baseline values within 48-72 h after administration of contrast medium. We observed the correlation between SYNTAX score and the CIN rates. Results CIN developed in 74（11.09%） of the 667 study patients. The CIN rate showed a positive trend in the 3 groups based on the SYNTAX score, the higher SYNTAX score corresponds to the higher incidence of CIN（6.93%,13.08%,13.51%P = 0.044）. In the multivariate analysis, SYNTAX score was identified as an independent predictor of CIN（OR：1.956,95% CI： 1.014-3.773; P = 0.045; OR： 1.942,95% CI： 1.005-3.752; P = 0.048）. The incidence of in-hospital（1.3% vs. 4, 21% vs. 5.86%, P = 0.035） and long-term MACE（4.59% vs. 7.88% vs. 11.66%, P = 0.046） rates were more frequent in the higner SYNTAX score groups. Conclusions SYNTAX score is an independent predictor of CIN among patients with CTO undergoing PCI.

绝经后女性冠心病患者冠脉造影SYNTAX评分与PLR、NLR、RDW的相关性

本文探讨绝经后女性冠心病患者冠脉造影SYNTAX评分与中性粒细胞-淋巴细胞比值(NLR)、血小板-淋巴细胞比值(PLR)、红细胞分布宽度(RDW)的相关性。选取139例绝经后女性冠心病患者(冠心病组),并选取同期139例绝经后伴胸痛、心慌胸闷等症状的疑似冠心病女性,但经冠状动脉造影检查后确认无冠心病患者(对照组),比较两组PLR、NLR、RDW,冠心病组均行冠脉造影检查,记录SYNTAX评分,比较不同SYNTAX评分患者PLR、NLR、RDW水平,应用Pearson及偏相关性分析冠脉造影SYNTAX评分与PLR、NLR、RDW关系。结果显示,冠心病组患者冠脉造影SYNTAX评分平均(26.68±9.15)分;冠心病组PLR、NLR、RDW高于对照组(P<0.05);PLR、NLR、RDW:高危>中危>低危,两两比较差异均有统计学意义(P<0.05);冠脉造影SYNTAX评分与PLR、NLR、RDW均呈正相关(P<0.05);将吸烟、高脂血症、糖尿病、高尿酸血症控制后,PLR、NLR、RDW仍与冠脉造影SYNTAX评分相关(P<0.05)。绝经后女性冠心病患者PLR、NLR、RDW升高,与冠心病发生及冠脉造影SYNTAX评分相关。

SYNTAX评分对冠状动脉单双支病变行经皮冠状动脉介入治疗患者长期预后的价值

目的探讨SYNTAX评分对冠状动脉单双支病变经皮冠状动脉介入治疗患者术后1年临床不良事件的预测价值。方法PANDAⅢ临床试验是一项前瞻性、多中心、全人群、随机对照研究,共入选了2013年12月至2014年8月来自46家中心的2348例患者。前瞻性地收集所有患者的SYNTAX评分,其中有1663例为冠状动脉单支或双支病变患者。根据SYNTAX评分将患者分为3组,其中SYNTAX评分≤22分为低分组(1388例),22分<SYNTAX评分≤32分为中分组(212例),SYNTAX评分>32分为高分组(63例)。结果低、中、高分组中分别有1378例(99.28%)、211例(99.53%)、63例(100.00%)患者完成了1年随访。主要不良心血管事件(MACE)发生率分别为低分组6.31%(87/1378)、中分组10.90%(23/211)、高分组20.63%(13/63),差异有统计学意义(P<0.001)。高分组全因死亡率明显高于低、中分组(11.11%比1.45%比1.42%,P<0.001)。所有患者心肌梗死的发生率随着SYNTAX评分的升高而增加(3.63%比7.58%比14.29%,P<0.001)。低、中、高分组中靶病变失败(TLF)事件的发生率差异也有统计学意义(4.57%比9.95%比12.70%,P<0.001)。随着SYNTAX评分升高靶血管心肌梗死的发生率增高(3.27%比7.58%比12.70%,P<0.001)。多因素分析显示年龄(HR 1.039,95%CI 1.020~1.057,P<0.001)和术前SYNTAX评分(HR 1.031,95%CI 1.012~1.050,P<0.001)是发生MACE的危险因素。结论对于冠状动脉单双支病变患者,SYNTAX评分是MACE的独立危险因素且有较好的预测价值。

Application of SYNTAX and its Derivative Scores in the Selection of Revascularization Strategies for Complex Coronary Heart Disease

Complex coronary heart disease(CHD)has become a hot spot in medicine due to its complex coronary anatomy,variable clinical factors,difficult hemodynamic reconstruction,and limited effect of conservative drug treatment.Identifying complex CHD and selecting optimal treatment methods have become more scientific as revascularization technology has improved,and coronary risk stratification scores have been introduced.SYNTAX and its derivative scores are decision-making tools that quantitatively describe the characteristics of coronary lesions in patients based on their complexity and severity.The SYNTAX and its derivative scores could assist clinicians in rationalizing the selection of hemodynamic reconstruction treatment strategies,and have demon-strated outstanding value in evaluating the prognosis of patients with complex CHD undergoing revascularization treatment.The authors in this article summary the practical application of SYNTAX and its derivative scores in complex CHD in order to deepen the understanding of the relationship between the choice of different revascularization strategies and SYNTAX and its derived scores in complex CHD and provide a further reference for clinical treatment of complex CHD.

冠心病患者中医证型与SYNTAX评分的相关性

目的:探讨冠心病患者中医辨证分型与SYNTAX评分及危险因素的相关性。方法:将符合标准的150例冠心病病人辨证分为六型,进行冠状动脉造影并采用SYNTAX评分评定冠状动脉病变程度。结果:冠心病病人中,女性偏于心肾阴虚证与气阴两虚证等虚证;而男性偏于痰浊闭阻证、心血瘀阻证与气滞血瘀证;随着年龄的增加,患者多表现为心肾阴虚证、气阴两虚证等证。气虚血瘀证的TC水平高于心血瘀阻证、气滞血瘀证、心肾阴虚证;心血瘀阻证的TG水平高于气虚血瘀证与痰浊闭阻证;痰浊闭阻证的LDL-C水平高于其余五组。痰浊闭阻型的SYNTAX评分均高于其他5型。结论:冠心病患者中医证型与年龄、性别存在一定相关性;不同证型患者TC、TG、LDL-C水平有所不同;痰浊闭阻证冠心病患者SYNTAX评分最高,病变更为复杂和显著。治疗上应重视健脾化痰与益气活血法的应用。

冠心病患者血浆同型半胱氨酸水平与冠状动脉病变SYNTAX积分的相关性研究

目的探讨冠心病患者血浆同型半胱氨酸(Hcy)水平与冠状动脉病变SYNTAX积分的相关性。方法选取2014年7—12月在宁夏医科大学总医院心内科就诊并经冠状动脉造影术(CAG)明确诊断为冠心病的患者225例为冠心病组,同时选取CAG阴性的患者51例为对照组。根据SYNTAX积分将冠心病组患者进一步分为低危组(n=74)、中危组(n=72)和高危组(n=79)。收集患者的一般资料[包括性别、年龄、BMI、收缩压(SBP)、舒张压(DBP)、吸烟史、饮酒史、既往史、既往用药情况等]、实验室检查结果 [包括空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血尿酸(SUA)、血肌酐(SCr)、超敏C反应蛋白(hs-CRP)、Hcy等]及心脏彩超检查结果 [包括左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)]。结果 4组年龄、SBP、DBP间差异无统计学意义(P>0.05),而BMI间差异有统计学意义(P<0.05)。4组男性比例、饮酒率及降糖药物、他汀类药物、抗血小板药物使用率间差异无统计学意义(P>0.05),而吸烟率和高血压、糖尿病、高脂血症发生率及降压药物使用率间差异有统计学意义(P<0.05)。4组FPG、TC、SUA、hs-CRP水平间差异无统计学意义(P>0.05),而Hb A1c、TG、LDL-C、HDL-C、SCr、Hcy水平及LVEDD、LVEF间差异有统计学意义(P<0.05)。Hcy水平与BMI、吸烟、高血压和Hb A1c、TC、LDL-C、SUA、SCr、hs-CRP水平及LVEDD呈正相关(P<0.05),与HDL-C水平及LVEF呈负相关(P<0.05);而与其他指标无明显相关(P>0.05)。SYNTAX积分与高血压和SCr、Hcy水平及LVEDD呈正相关(P<0.05),与TG、HDL-C水平及LVEF呈负相关(P<0.05);而与其他指标无明显相关(P>0.05)。多因素Logistic回归分析结果显示,吸烟、高血压和LDL-C、HDL-C、Hcy水平及LVEF是SYNTAX积分的独立影响因素(P<0.05)。结论冠心病患者血浆Hcy水平与SYNTAX积分呈正相关,测定血浆Hcy水平有利于预测冠心病患者的冠状动脉病变复杂程度。

SYNTAX Ⅱ评分对急性ST段抬高型心肌梗死患者直接PCI术后无复流的预测价值

目的评价SYNTAX评分与SYNTAXⅡ评分在预测急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,pPCI)后无复流现象的价值。方法选取2016年1月至2017年1月就诊于首都医科大学附属北京安贞医院急诊危重症中心,且发病12 h内经冠状动脉造影确定需行pPCI的STEMI患者,共计384例,按照pPCI术后是否发生无复流现象分为无复流组(76例)与正常血流组(308例)。对所有入选对象分别进行SYNTAX评分和SYNTAX II评分,并收集相关的临床特征及实验室检查资料。通过单因素及多因素Logistics回归分析及受试者工作特征(receiver operating characteristic,ROC)曲线分析,比较SYNTAX评分与SYNTAX评分II两种评分方法对STEMI患者冠状动脉无复流现象的预测价值。结果单因素分析SYNTAX评分及SYNTAX II评分均与冠状动脉无复流现象有关,但多因素分析只有SYNTAX II评分与无复流现象由关联,SYNTAX II评分高,发生冠状动脉无复流现象的危险性增加;ROC曲线分析显示SYNTAX评分II曲线下面积>SYNTAX评分,差异有统计学意义(0.905 vs 0.818,P<0.001),预测无复流现象的敏感度和特异度高于SYNTAX评分。结论SYNTAX II评分高分是无复流现象发生的独立影响因素,与SYNTAX评分相比,有更好的预测价值。

GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征患者的远期预后评估

目的:明确GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征(NSTE-ACS)远期预后的评估价值。方法:回顾性分析2009-01至2014-01住院诊断为NSTE-ACS的患者共784例,其中单纯药物治疗组410例,支架组325例,CABG组49例。计算患者的GRACE评分和SYNTAX评分,按照评分分为低、中、高危三组。GRACE评分和SYNTAX评分的关系采用Pearson相关分析;生存分析采用Kaplan-Meier法;用Cox比例风险模型进行单因素及多因素分析。计算受试者工作特征(ROC)曲线下面积比较预测方法的优劣性。结果:研究完成随访784例,随访中位时间为47.7个月。Pearson相关分析显示,GRACE评分和SYNTAX评分存在较弱的正相关(r=0.40,P<0.01);生存分析结果表明,GRACE评分得出的低、中、高危三组的主要不良心血管事件(MACE)发生率逐渐升高(依次为13.81%、23.64%和36.55%,P<0.001);SYNTAX评分得出的中、高危组的MACE发生率(分别为39.29%和37.93%)均高于低危组(23.99%),但中危组和高危组之间的差异无统计学意义(P>0.05)。Cox回归和ROC分析显示,GRACE评分和SYNTAX评分对NSTE-ACS的长期预后评估均有重要价值。将GRACE评分、SYNTAX评分及GRACE和SYNTAX联合评分进行ROC曲线分析后发现,三者对NSTE-ACS患者远期MACE风险均有良好的预测价值,但三者的95%可信区间明显重叠,预测价值的差异无统计学意义。结论:GRACE评分和SYNTAX评分存在相关性,二者对NSTE-ACS的远期预后评估均有重要价值,预测价值无明显差异,即使两者联合也并不提高预测价值。利用GRACE评分对NSTE-ACS患者的远期预后进行低、中、高危分层是适宜的。

残余SYNTAX评分在中国冠心病介入患者中的应用价值研究

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。

不适合冠状动脉旁路移植术的SYNTAX评分≥33分的冠心病患者在血流储备分数指导下行介入治疗的临床观察

目的:观察不适合冠状动脉(冠脉)旁路移植术(CABG)的SYNTAX评分≥33分冠心病患者在血流储备分数(FFR)指导下行经皮冠脉介入治疗(PCI)的近、远期临床疗效治疗。方法:收集2012-01至2015-06期间SYNTAX评分≥33分且EuroS CORE评分>6分的冠心病患者共117例。经心脏团队会诊认为不适合外科手术,分为单纯药物治疗(药物治疗组,n=20)和PCI(PCI组,n=97)。其中PCI组在FFR指导下PCI术,术中根据术者经验选择旋磨和(或)血管内超声检查。所有患者随访至少12个月。同时以"冠脉支架+搭桥"、"CABG+PCI"为主题词检索2012-01-01至2015-12-31内的维普中文科技期刊全文数据库、万方医学数据库、中国知网和中国生物医学文献数据库的相关文献,将本中心的研究结果与其进行比较以了解临床获益情况。结果:(1)PCI组和药物治疗组SYNTAX评分和Euro SCORE评分基本一致,差异无统计学意义(P>0.05)。病变方面,均以左前降支受累为常见。而在部分血运重建的患者中,慢性闭塞病变所占比例较多,占31.3%(5/16)。(2)PCI组共发生主要不良心脑血管事件(MACCE)共18例,发生率18.6%(18/97),其中随访期死亡2例,再次血运重建9例。药物治疗组发生MACCE共12例,发生率60.0%(12/20),其中随访期死亡3例。两者比较差异有统计学意义(P<0.05)。PCI术中并发症并无明显增加。(3)检索到同时期临床研究共22项。本中心PCI组MACCE发生率与22项研究报道的MACCE发生率差异无统计学意义(P>0.05),药物治疗组的MACCE发生率明显增加(P<0.05)。结论:对于不适合CABG的SYNTAX积分≥33分的冠心病患者在FFR指导下行PCI治疗可以带来临床获益。