不同SYNTAX评分对冠状动脉旁路移植术后患者临床结局预测价值的比较

目的 探讨SYNTAX评分（SS）及SYNTAX评分Ⅱ（SS-Ⅱ）对冠状动脉旁路移植术（CABG）后患者长期临床结局的预测价值。方法 连续纳入行CABG的符合标准的患者308例,分别计算SS及SS-Ⅱ,根据三分位数法,将患者分为低、中、高分组,随访患者的主要不良心血管事件（MACE）。采用Kaplan-Meier生存分析、受试者工作特征曲线及Cox回归分析,评价两种评分对CABG术后MACE预测的准确性。结果 中位随访期为63个月,MACE发生率为30.5%。按SS和SS-Ⅱ分组,各组间MACE、再次血运重建、非致死性心肌梗死事件发生率差异均有统计学意义（均P＜0.01）。SS及SS-Ⅱ低、中、高分组患者累积无MACE生存率差异有统计学意义（均P＜0.01）。SS及SS-Ⅱ是预测MACE的可靠工具（AUC分别为0.664和0.751）,且SS-Ⅱ对MACE的预测效能优于SS（Z=2.296,P＜0.05）。多因素 Cox 回归分析显示,SS（中、高分组 HR 分别为 2.577 和 4.428）和 SS-Ⅱ（中、高分组 HR 分别为 2.343 和 5.108）是MACE的危险因素。结论 SS及SS-Ⅱ均与CABG术后MACE有关,是评估因冠心病行CABG治疗患者远期预后的预测指标。SS-Ⅱ对MACE的预测价值优于SS。

Comparison of the predictive values of different SYNTAX scores on the clinical outcome ofpatients after coronary artery bypass grafting

Objective To evaluate the predictive values of SYNTAX score (SS) and SYNTAX score Ⅱ (SS-Ⅱ) for thelong-term outcomes of patients after coronary artery bypass grafting (CABG). Methods Data of 308 consecutive patientsunderwent CABG were collected in this study. The SS and SS-Ⅱ scores were calculated for each patient. Patients werestratified into low, middle and high score groups according to the tertiles of SS and SS-Ⅱ. The major adverse cardiovascularevents (MACE) were followed up for patients. Kaplan-Meier was used for survival analysis. ROC curve and Cox regressionanalysis were used to evaluate the predictive values of SS and SS-Ⅱ for MACE. Results At a median follow-up of 63months, the cumulative incidence of MACE was 30.5%. According to either SS or SS-Ⅱ, there were significant differencesin MACE, repeat revascularization and non-fatal myocardial infarction between the three groups (P＜0.01). There weresignificant differences in the cumulative survival rates of non-MACE between three groups (P＜0.01). SS (AUC=0.664) andSS-Ⅱ (AUC=0.751) were reliable predictors of MACE. The predictive effect of SS-Ⅱ for MACE was significantly higherthan that of SS (Z=2.296,P＜0.05). Multivariate Cox regression analysis showed that SS (HR 2.577 for the middle group; HR4.428 for the high group) and SS-Ⅱ (HR 2.343 for the middle group; HR 5.108 for the high group) were risk factors forMACE. Conclusion Both SS and SS-Ⅱ are correlated with MACE in patients after CABG, and they are predictors forevaluating the long-term prognosis of patients with coronary heart disease treated with CABG. The predictive value of SS-Ⅱfor MACE is better than that of SS.