Military Institute of Medicine.
Kardiol Pol. 2013;71(8):803-9. doi: 10.5603/KP.2013.0191.
In patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS), the long-term risk of deathand myocardial infarction (MI) is estimated by scores based on noninvasively derived variables. Much less is known about the relation between the degree of atherosclerotic burden in the coronary tree and the long-term risk of patients with NSTE-ACS.
To evaluate the accuracy of a wide spectrum of coronary angiographic and clinical data in predicting outcomes ina long-term follow-up of patients successfully treated invasively for NSTE-ACS.
The study group consisted of 112 consecutive patients (age 62 ± 10 years; 76 men) treated invasively for NSTE-ACS.27 (24%) patients had a history of diabetes mellitus (DM) and 37 (33%) patients a history of MI. The coronary angiograms priorto intervention were evaluated blindly for the four angiographic scores: (1) Stenosis score derived from the assessment of thedegree of stenosis in 15 segments of the coronary tree; (2) Vessel score showing the number of main vessels stenosed > 70%; (3) Extensity score assessing the proportion of lumen length irregularity in 15 segments; and (4) Complexity score describingthe number of complex plaques. The angiographic analysis also focused on the flow, presence of thrombus and collateralsupply prior to intervention (according to TIMI) and the size of the culprit lesion vessel. The intervention was successful in 95% of cases. All patients were followed-up for 6-24 months for the occurrence of death or MI.
In the follow-up period, the composite end point of death or MI occurred in 20 (17%) patients. In order to indicate therisk predictors from the group of clinical and angiographic variables (age, sex, history of DM, history of MI, four angiographicscores and culprit lesion vessel characterisation), logistic regression analysis was performed. The independent angiographic predictors of composite end point (selected by forward conditional selection) were stenosis score (OR 1.13; 95% CI 1.05-1.2;p < 0.001) and size of the vessel (OR 0.08; 95% CI 0.01-0.6; p = 0.02).
Our preliminary data shows that attempting to add angiographic variables into the risk assessment scoring systems in order to strengthen their predictive accuracy is justified.
在非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者中，通过基于无创衍生变量的评分来估计死亡和心肌梗死（MI）的长期风险。对于 NSTE-ACS 患者，冠状动脉树中动脉粥样硬化负担程度与长期风险之间的关系知之甚少。
评估广泛的冠状动脉造影和临床数据在预测成功接受 NSTE-ACS 侵入性治疗的患者长期预后方面的准确性。
研究组包括 112 例连续接受 NSTE-ACS 侵入性治疗的患者（年龄 62±10 岁；76 名男性）。27（24%）例患者有糖尿病（DM）病史，37（33%）例患者有 MI 病史。在进行介入治疗之前，对冠状动脉造影进行盲法评估，评估以下四个血管造影评分：（1）狭窄评分，评估冠状动脉树 15 个节段的狭窄程度；（2）血管评分，显示>70%狭窄的主要血管数量；（3）广泛评分，评估 15 个节段的管腔长度不规则比例；（4）复杂程度评分，描述斑块数量。血管造影分析还集中于介入前（根据 TIMI）的血流、血栓形成和侧支供应以及罪犯病变血管的大小。95%的患者成功进行了介入治疗。所有患者在 6-24 个月的随访期间均出现死亡或 MI 的复合终点事件。
在随访期间，20 例（17%）患者发生死亡或 MI 的复合终点事件。为了从临床和血管造影变量（年龄、性别、DM 病史、MI 病史、四个血管造影评分和罪犯病变血管特征）中确定风险预测因素，进行了逻辑回归分析。复合终点事件的独立血管造影预测因素（通过向前条件选择选择）是狭窄评分（OR 1.13；95%CI 1.05-1.2；p<0.001）和血管大小（OR 0.08；95%CI 0.01-0.6；p=0.02）。
我们的初步数据表明，尝试将血管造影变量纳入风险评估评分系统以提高其预测准确性是合理的。
