徐昕晔,凌云鹏,郭丽君

• 1:北京大学第三医院心内科卫生部心血管分子生物学与调节肽卫生部重点实验室分子心血管教育部重点实验室
• 2:北京大学第三医院心外科

摘要(Abstract)：

目的通过分站式杂交冠状动脉血运重建术(hybrid coronary revascularizasion,HCR)SYNTAXⅠ评分特征进行分析和观察不同阶段SYNTAXⅡ评分变化,评价依据术前SYNTAXⅡ评分选择HCR手术策略的可行性。方法回顾性分析2016年1月1日至2017年12月31日在北京大学第三医院接受分站式HCR的患者共50例,计算微创冠状动脉旁路移植术(minimally invasive direct coronary artery bypass grafting,MIDCAB)前总SYNTAXⅠ评分,据此计算术后SYNTAXⅠ评分及预估SYNTAXⅡ评分,比较预估的MIDCAB术后SYNTAXⅡ评分与实际SYNTAXⅡ评分的差异。结果在MIDCAB术前SYNTAXⅠ评分为36.00(13.00,70.50)分,SYNTAXⅠ评分>33分患者29例(58.0%),MIDCAB术后残余病变SYNTAXⅠ评分为11.50(7.00,18.50)分,较术前SYNTAXⅠ评分降低21.50(9.0,27.50)分。MIDCAB术前肌酐清除率(Ccr)为72.53(32.00,137.03)ml/min,术后复查Ccr为82.48(33.05,145.00)ml/min,较MIDCAB术前增加了8.87(–20.12,41.73)ml/min(P<0.001)。MIDCAB术前预测术后SYNTAXⅡ[经皮冠状动脉介入治疗(PCI)]评分为27.25(15.80,45.90)分,实际评分为27.20(15.90,52.30)分,增加了1.60(–4.80,11.40)分,差异有统计学意义(P=0.001);术前预测行PCI的4年死亡率为5.45%(2.00%,23.50%),实际死亡率为5.40%(2.10%,36.90%),增加了0.6%(–5.40%,13.40%),差异有统计学意义(P<0.001)。MIDCAB术前预测术后SYNTAXⅡ[冠状动脉旁路移植术(CABG)]评分为23.20(5.20,43.70)分,实际评分为23.65(4.20,40.70)分,增加了0.60(–6.30,5.70)分,差异有统计学意义(P=0.023);术前预测行CABG的4年死亡率为3.90%(0.90%,20.10%),实际死亡率为4.05%(0.80%,15.90%),增加了0.20%(–7.60%,3.00%),差异有统计学意义(P=0.044)。根据MIDCAB术前预估的SYNTAXⅡ评分,10.0%(5/50)患者行PCI术后4年死亡率低于CABG;对MIDCAB术后SYNTAXⅡ评分进行预测,该比例为38.0%(19/50),而实际比例为42.0%(21/50),预测值与实际值相符合的比例为90%(45/50,P=0.125)。结论预估MIDCAB术后SYNTAXⅡ评分指导手术策略的尝试是可行的。MIDCAB术前、术后SYNTAXⅡ评分的变化主要来源于术后Ccr的改善。

关键词(KeyWords)： 杂交冠状动脉血运重建术;SYNTAXⅠ评分;微创冠状动脉旁路移植术

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(青年基金)(81400293);; 北京大学第三医院临床重点项目(BYSY2015007)

作者(Author): 徐昕晔,凌云鹏,郭丽君

参考文献(References)：

• [1]Harskamp RE,Bagai A,Halkos ME,et al.Clinical outcomes after hybrid coronary revascularization versus coronary artery bypass surgery:a meta-analysis of 1,190 patients.Am Heart J,2014,167(4):585-592.
• [2]Sardar P,Kundu A,Bischoff M,et al.Hybrid coronary revascularization versus coronary artery bypass grafting in patients with multivessel coronary artery disease:a meta-analysis.Catheter Cardiovasc interv,2018,91(2):203-212.
• [3]Kappetein AP,Head SJ,Morice MC,et al.Treatment of complex coronary artery disease in patients with diabetes:5-year results comparing outcomes of bypass surgery and percutaneous coronary intervention in the SYNTAX trial.Eur J Cardiothorac Surg,2013,43(5):1006-1013.
• [4]王贵松,高炜.SYNTAX积分对左主干和多支血管病变患者临床结果的预测价值.中国介入心脏病学杂志,2011,19(1):47-49.
• [5]Inal BB,Oguz O,Emre T,et al.Evaluation of MDRD,CockcroftGault,and CKD-EPI formulas in the estimated glomerular filtration rate.Clin Lab,2014,60(10):1685-1694.
• [6]Mitchell C,Rahko PS,Blauwet LA,et al.Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults:recommendations from the American Society of Echocardiography.JAm Soc Echocardiogr,2019,32(1):1-64
• [7]Kappetein AP,Dawkins KD,Mohr FW,et al.Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease.Ⅰnsights from the SYNTAX run-in phase.Eur J Cardiothorac Surg,2006,29(4):486-491.
• [8]Puskas JD,Halkos ME,DeRose JJ,et al.Hybrid coronary revascularization for the treatment of multivessel coronary artery disease:a multicenter observational study.J Am Coll Cardiol,2016,68(4):356-365.
• [9]Rosenblum JM,Harskamp RE,Hoedemaker N,et al.Hybrid coronary revascularization versus coronary artery bypass surgery with bilateral or single internal mammary artery grafts.J Thorac Cardiovasc Surg,2016,151(4):1081-1089.
• [10]G?sior M,Zembala MO,Tajstra M,et al.Hybrid revascularization for multivessel coronary artery disease.JACC Cardiovasc Interv,2014,7(11):1277-1283.
• [11]Zhang L,Cui Z,Song Z,et al.Minimally invasive direct coronary artery bypass for left anterior descending artery revascularization-analysis of 300 cases.Wideochir Inne Tech Maloinwazyjne,2016,10(4):548-554.
• [12]Dou K,Zhang D,Xu B,et al.An angiographic tool based on visual estimation for risk prediction of side branch occlusion in coronary bifurcation intervention:the V-RESOLVE score system.Euro Intervention,2016,11(14):e1604-e1611.