Wang Gang, Hua Qi, Li Jing, Zhu Weiwei, Luo Hongyu, Zhang Yuhui, Wang Chen
Department of cardiology, Xuanwu Hospital, Capital Medical University.
Cardiol J. 2016;23(3):317-23. doi: 10.5603/CJ.a2016.0006. Epub 2016 Jan 18.
SYNTAX score II (SS-II) has been demonstrated to predict long-term outcomes in unprotected left main or multiple vessels in patients with coronary artery disease. However, its prognostic value for patients with ST-segment elevation myocardial infarction (STEMI) remains unknown. The poor myocardial perfusion (myocardial blush grade [MBG] 0/1) after primary percutaneous coronary intervention (pPCI) has a negative prognostic value in patients with STEMI. We aimed to assess SS-II and its possible relationships with MBG 0/1 in patients with STEMI treated with pPCI.
The study included 477 patients with STEMI who underwent pPCI between October 2010 and May 2014. SYNTAX Score II and MBG were determined in all patients. Myocardial blush grade were divided into MBG 0/1 (poor myocardial perfusion) and MBG 2/3 (normal myocardial perfusion). Patients were divided into three tertiles: SS-IIlow (￡ 20), SS-IIintermediate (20-26) and SS-IIhigh (≥ 26).
Compared with the SS-IIintermediate and SS-IIlow tertiles, the SS-IIhigh tertile had more MBG 0/1 (46.1%, 32.1% and 21.8%, p < 0.001, respectively). On multivariate logistic regression analysis, SS-II was an independent predictor of MBG 0/1 (hazard ratio 1.084, 95% confidence interval 1.050-1.119, p < 0.001). Receiver operating characteristic analysis identified SS-II > 24 as the best cut-off value predicting MBG 0/1 (sensitivity of 66%, specificity of 54%).
High SS-II is an independent predictor of MBG 0/1 in patients with STEMI undergoing pPCI.
SYNTAX评分II（SS-II）已被证明可预测冠心病患者无保护左主干或多支血管病变的长期预后。然而，其对ST段抬高型心肌梗死（STEMI）患者的预后价值仍不清楚。直接经皮冠状动脉介入治疗（pPCI）后心肌灌注不良（心肌 blush分级[MBG]为0/1）对STEMI患者具有负面预后价值。我们旨在评估STEMI患者接受pPCI治疗时的SS-II及其与MBG 0/1的可能关系。
本研究纳入了2010年10月至2014年5月期间接受pPCI的477例STEMI患者。测定所有患者的SYNTAX评分II和MBG。心肌 blush分级分为MBG 0/1（心肌灌注不良）和MBG 2/3（心肌灌注正常）。患者分为三个三分位数：SS-II低（≤20）、SS-II中等（20 - 26）和SS-II高（≥26）。
与SS-II中等和SS-II低三分位数相比，SS-II高三分位数的MBG 0/1更多（分别为46.1%、32.1%和21.8%，p < 0.001）。多因素逻辑回归分析显示，SS-II是MBG 0/1的独立预测因子（风险比1.084，95%置信区间1.050 - 1.119，p < 0.001）。受试者工作特征分析确定SS-II > 24为预测MBG 0/1的最佳截断值（敏感性为66%，特异性为54%）。
高SS-II是接受pPCI的STEMI患者MBG 0/1的独立预测因子。
