SYNTAX评分对无保护左主干病变选择不同血运重建方式的价值研究

目的:应用SYNTAX评分评估冠状动脉(冠脉)无保护左主干病变(ULMCA)的复杂程度及其与临床事件的相关性,探讨冠脉无保护左主干病变患者的最佳血运重建方式。方法:回顾性收集了206例从2003-02至2008-01采用经皮冠脉介入治疗—药物洗脱支架(PCI-DES)和冠脉旁路移植术(CABG)的无保护左主干病变患者,其中CABG组94例,PCI-DES组112例。收集患者的基本情况、左主干病变特点及SYNTAX评分、CABG和PCI手术情况,随访患者术后3年的主要不良心脑血管事件(MACCE)发生率以及冠脉造影复查情况。结果:①两组患者基本情况、左主干病变特点及SYNTAX评分等方面差异均无统计学意义(P>0.05),但CABG组合并三支血管病变多于PCI-DES组,差异有统计学意义74.47%(70例)vs.41.07%(46例),P<0.01]。②住院期间CABG组的MACCE发生率较PCI-DES组高(P<0.05)。术后3年随访,两组的MACCE发生率及无MACCE生存率比较差异无统计学意义,但PCI-DES组靶血管再次血运重建率明显高于CABG组(P<0.05)。③两组间SYNTAX评分差异无统计学意义(P>0.05)。PCI-DES组中,高积分(≥30.0)患者术后3年MACCE发生率明显高于低积分(<30.0)患者(P<0.01),而术后3年无MACCE生存率低于低积分患者(P<0.01)。CABG组中,高积分和低积分患者术后3年MACCE发生率及无MACCE生存率比较差异无统计学意义(P>0.05)。高积分患者中,术后3年PCI-DES组MACCE发生率高于CABG组,无MACCE生存率低于CABG组(P均<0.05)。低积分患者中,术后3年PCI-DES组MACCE发生率低于CABG组,无MACCE生存率PCI-DES组高于CABG组(P均<0.05),差异均有统计学意义。结论:用SYNTAX评分指导无保护左主干病变的血管重建方式选择有重要价值,但在不同的患者中,仍应结合临床特征和冠脉病变特点选择恰当的血运重建术。

Evaluation of SYNTAX Score for Selecting the Optimal Revascularization Strategies in Patients With Unprotected Left Main Coronary Artery Disease

Objective:To explore the relationship between the severities of unprotected left main coronary artery(ULMCA) disease with the major adverse clinical events by syntax score system evaluation,and to find the optimal revascularization strategies.Methods:We retrospectively summarized 206 consecutive ULMCA patients who received PCI with drug eluting stent(PCI-DES) or coronary artery bypass grafting(CABG) from 2003 to 2008 in our hospital.CABG group,n=94 and PCI-DES group,n=112.The patients with syntax score≥30 were defined as high score,syntax score<30 as low score.We studied the basic information,the characteristics of left main lesion with syntax score,the operational condition and major adverse cardiac and cerebrovascular events(MACCE)for 3 years follow-up time.Result:①The basic information and left main lesion characteristics with syntax score were similar between two groups,P>0.05.While there were more patients with 3-vessel disease in CABG group than those in PCI-DES group,P<0.01.②The in-hospital MACCE occurrence rate was higher in CABG group than that in PCI-DES group,P<0.05.For 3 years follow-up,the MACCE occurrence and MACCE free survival rate were no real differences between two groups.The revascularization rate was higher in PCI-DES group,P<0.05.③The syntax score had no real difference between two groups,P>0.05.At 3 years after the operation,in PCI-DES group,the high score patients had increased MACCE occurrence and decreased MACCE free survival rate than low score patients,P<0.01 respectively,while in CABG group,there were no statistic differences,P>0.05.In high score patients,PCI-DES group had increased MACCE occurrence and decreased MACCE free survival rate than CABG group,P<0.05 respectively.In low score patients,PCI-DES group had decreased MACCE occurrence and increased MACCE free survival rate than CABG group,P<0.05 respectively.Conclusion:Syntax score system is valuable for selecting the optimal revascularization strategies in patients with ULMCA disease,it is important to make proper revascularization in different patient.