刘晓红,李为民

• 1:哈尔滨医科大学附属第一医院心血管内科

摘要(Abstract)：

目的探讨残余SYNTAX评分(r SS)对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后主要不良心脑血管事件(MACCE)的预测价值。方法回顾性分析哈尔滨医科大学附属第一医院2016年6–12月接受PCI术的AMI患者720例,排除既往冠状动脉旁路移植术(CABG)、冠状动脉造影显示左右冠状动脉均衡型、资料不全、失访者共232例,最终入组488例接受PCI术的AMI患者。计算基线SYNTAX评分和r SS。临床随访1.5年,终点事件为MACCE(全因死亡、再发心肌梗死、卒中、再次血运重建的复合终点)。结果 488例患者随访期间MACCE发生率为9.8%,logistic多因素回归分析显示,r SS(OR 1.152,95%CI 1.097～1.210,P<0.001)是AMI患者PCI术后发生MACCE的独立危险因素,且r SS预测AMI患者PCI术后发生MACCE的合适截断值为>5分,灵敏度和特异度分别为72.9%、65.2%(曲线下面积0.738,P<0.001)。再根据r SS合适截断值分为r SS=0分、0分5分三组,显示r SS>5分组年龄更大、基础疾病更多、冠状动脉病变更复杂,且r SS>5分组MACCE发生率显著高于其他两组,0分

关键词(KeyWords)： 残余SYNTAX评分;急性心肌梗死;经皮冠状动脉介入治疗;主要不良心脑血管事件

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘晓红,李为民

参考文献(References)：

• [1] Sianos G, Morel MA, Kappetein AP,et al. The SYNTAX Score:an angiographic tool grading the complexity of coronary artery disease.EuroIntervention, 2005,1(2):219-227.
• [2] Gen?er?eux P, Palmerini T, Caixeta A, et al. Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention:the residual SYNTAX(Synergy Between PCI with Taxus and Cardiac Surgery)score. J Am Coll Cardiol,2012,59(24):2165-2174.
• [3] Neumann FJ, Sousa-Uva M, Ahlsson A,et al.2018 ESC/EACTS Guidelines on myocardial revascularization. Kardiol Pol, 2018,76(12):1585-1664.
• [4]周玉杰,刘巍. 2018年欧洲心脏协会和欧洲心胸外科协会血运重建指南解读.中国介入心脏病学杂志,2018,26(9):497-500.
• [5] Sandoval Y, Brilakis ES, Canoniero M,et al. Complete versus incomplete coronary revascularization of patients with multivessel coronary artery disease. Curr Treat Options Cardiovasc Med, 2015,17(3):366.
• [6] Farooq V, Serruys PW, Bourantas C V, et al. Quantification of incomplete revascularization and its association with five-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery(SYNTAX)trial validation of the residual SYNTAX score. Circulation, 2013,128(2):141-151.
• [7] Witberg G, Lavi I, Assali A,et al. The incremental impact of residual SYNTAX score on long-term clinical outcomes in patients with multivessel coronary artery disease treated by percutaneous coronary interventions. Catheter Cardiovasc Interv, 2015,86(1):3-10.
• [8] Khan R, Al-Hawwas M, Hatem R,et al. Prognostic impact of the residual SYNTAX score on in-hospital outcomes in patients undergoing primary percutaneous coronary intervention. Catheter Cardiovasc Interv, 2016,88(5):740-747.
• [9] Braga CG, Cid-Alvarez AB, Diéguez AR,et al. Prognostic impact of residual SYNTAX score in patients with ST-elevation myocardial infarction and multivessel disease:Analysis of an 8-year all-comers registry. Int J Cardiol,2017,243:21-26.
• [10] Malkin CJ, George V, Ghobrial MS,et al. Residual SYNTAX score after PCI for triple vessel coronary artery disease:quantifying the adverse effect of incomplete revascularization. EuroIntervention,2013,8(11):1286-1295.
• [11] Azzalini L, Candilio L, Ojeda S, et al. Impact of incomplete revascularization on long-term outcomes following chronic total occlusion percutaneous coronary intervention. Am J Cardiol, 2018,121(10):1138-1148.
• [12]高国峰,丰雷,赵延延,等.残余SYNTAX评分在中国冠心病介入患者中的应用价值研究.中国循环杂志,2018,33(2):117-122.
• [13] Alidoosti M, Saroukhani S, Lotfi-Tokaldany M,et al. Objectifying the level of incomplete revascularization by the residual SYNTAX score and evaluating its impact on the one-year outcome of percutaneous coronary intervention in patients with multi-vessel disease. Cardiovasc Revasc Med, 2016,17(5):308-312.
• [14] Nam CW, Mangiacapra F, Entjes R, et al. Functional SYNTAX score for risk assessment in multivessel coronary artery disease. J Am Coll Cardiol, 2011,58(12):1211-1218.
• [15] Kobayashi Y, Nam CW, Tonino PA, et al. The Prognostic value of residual coronary stenoses after functionally complete revascularization. J Am Coll Cardiol, 2016,67(14):1701-1711.
• [16] Kobayashi Y, L?nborg J, Jong A, et al. Prognostic value of the residual SYNTAX score after functionally complete revascularization in ACS. J Am Coll Cardiol, 2018,72(12):1321-1329.
• [17] Choi KH, Lee JM, Koo BK, et al. Prognostic implication of functional incomplete revascularization and residual functional SYNTAX score in patients with coronary artery disease. JACC Cardiovasc Interv, 2018,11(3):237-245.
• [18] Gao G, Feng L, Zhang D, et al. Proximal left anterior descending coronary artery stenosis should be considered when using the prognostic value of the residual SYNTAX score:Data from 10343consecutive patients with long-term follow up in the real world.Catheter Cardiovasc Interv, 2018,91(S1):639-645.