SYNTAX评分系统在冠脉多支病变患者血运重建方式选择中的应用

目的应用SYNTAXSCORE评估冠状动脉多支病变的复杂程度及其与临床事件的相关性，探讨它对多支病变患者临床结果的预测价值和冠脉多支病变患者的最佳血运重建方式．方法回顾性分析2006年1月至2013年1月经冠脉造影证实为多支病变并接受药物洗脱支架治疗（PCI-DES）和冠脉旁路移植术（CABG）的316例患者．其中CABG组151例，PCI-DES组165例．收集患者的基本情况、SYNTAX评分、冠脉旁路移植手术和PCI手术情况，并通过门诊或电话随访主要不良心脑血管事件（MACCE），包括全因死亡、非致命性心肌梗死、再次血运重建、中风以及冠脉造影复查情况．结果（1）PCI-DES与CABG2组在患者基线资料方面相比无显著性差异（P〉0．05）．（2）住院期间CABG组的MACCE事件发生率较PCI组高（P〈0．05）．术后36个月随访，2组的MACCE发生率及无MACCE生存率比较差异无统计学意义（P〉0．05），但PCI组靶血管再次血运重建率（TvR）都明显高于CABG组（P〈0．05）．（3）PCI-DES和CABG2组间SYNTAXSCORE评分差异无统计学意义（P〉0．05）．多因素分析结果显示，SYNTAX积分〉24分是MACCE的独立预测因子（P=O．O1，OR=18．715，95％可信区间1．316至273．624）．PCI-DES组中，高积分亚组术后36个月MACCE事件发生率明显多于低积分亚组〈24．0（P〈0．01）．CABG组中，高积分和低积分两亚组术后36个月MACCE事件发生率及无MACCE事件生存率比较差异无统计学意义（P〉0．05）．高积分患者中，术后36个月PCI-DES亚组MACCE事件发生率高于CABG亚组（P〈0．05）．低积分患者中，术后36个月MACCE事件发生率CABG亚组高于PCI-DES亚组（P〉0．05）．结论SYNTAX评分系统在冠脉多支病变患者血管重建方式的选择和预后评估中具有重要价值．

Application of SYNTAX Score System in Selecting Optimal Revascularization Strategies for Patients with Multivessel Diseases

Objective To evaluate the complexity degree of muhivessel coronary disease and its correlationswith major adverse cardiac and cerebrovascular event （MACCE） by syntax score system and investigate the predictive value of SYNTAX Score and the optimal revascularization strategy for the patients with muhivessel disease. Methods We reviewed outcomes among 316 consecutive patients with multivessel disease who underwent PCI or CAGB in Yunnan province between January 2006 and January 2013. One hundred and fifty-one of them underwent CABG （CABG group） and one hundred and sixty-five of them received drug-eluting stents （PCI group） . Baseline features, angiographic characteristics, syntax score , operation data and the major adverse clinical event （MACCE） rates at 36 months were recorded. Results （1） There was no significant difference between the PCI-DES and CABG groups in baseline characteristics （gender, age, hypertension, diabetes, left wntr;~,,l~rejection fraction, angiographic characteristics, SYNTAX Score ） （2） There were more target vessel revascularization events in the PCI group than in the CABG group, although MACCE and MACCE-free rates were similar at 3 years follow-up. （3） Patients were divided into high-score group （〉24） and low-score group （〈 24） by SYNTAX Score system. SYNTAX Score 〉24.0 is the independent risk factor of the outcomes of PCI . Compared with low-score group, MACCE was increased in the high-score group of the patients underwent PCI and MACCE-free rate was decreased at 3 years follow-up （P〈0.01） , but there were no significant difference in MACCE and MACCE-free rates between low-score group and high-score group of the patients underwent CABG （P〉O.05） . In the high-score group, MACCE was higher and MACCE-free rate was lower at 3 years in patients underwent PCI than CABG （P〈0.05） . In the low-score group, MACCE was lower and MACCE-free rate was higher in patients underwent PCI than CABG at 3 years （P〈0.05） Conclusion Syntax score system is valuable for predicting the prognosis and selecting optimal revascularization strategies for patients with multivessel disease.