ST段抬高型心肌梗死多支血管病变患者基线SYNTAX评分与临床SYNTAX评分的长期预后价值比较

Comparison of long-term prognostic value of baseline SYNTAX and clinical SYNTAX scores in ST-segment elevation myocardial infarction patients with multivessel disease.

作者信息

Onuk Tolga, Güngör Bariş, İpek Göktürk, Karataş Mehmet B, Çanga Yiğit, Akyüz Şükrü, Haci Recep, Karadeniz Fatma Özpamuk, Sungur Aylin, Kaşikçioğlu Hülya, Çam Neşe

机构信息

aDepartment of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul bDepartment of Cardiology, Erzurum Training and Research Hospital, Erzurum cDepartment of Cardiology, Necip Fazil State Hospital, Kahramanmaras, Turkey.

出版信息

Coron Artery Dis. 2016 Jun;27(4):311-8. doi: 10.1097/MCA.0000000000000365.

DOI:10.1097/MCA.0000000000000365

PMID:26945185

Abstract

BACKGROUND

The prognostic value of baseline SYNTAX (SS) and clinical SYNTAX (cSS) scores has been shown in different populations with coronary artery disease. However, their prognostic value has not been compared in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease.

METHODS

Patients who had undergone a primary percutaneous coronary intervention (PCI) for STEMI and had at least one critical lesion other than the culprit artery were recruited retrospectively. SS and cSS were calculated from medical records and angiograms and were compared in coronary artery by-pass grafting (CABG) and PCI groups. Long-term major adverse cardiac events (MACE) were defined as mortality, reinfarction, and target vessel revascularization.

RESULTS

A total of 460 patients (214 in the CABG group and 246 in the PCI group) were analyzed. The baseline SS and the cSS were significantly higher in the CABG group compared with the PCI group (30.1±6.7 vs. 22.5±5.6; P<0.01 and 41.4±21.2 vs. 27.2±15.9; P<0.01, respectively). During a follow-up period of 32±8 months, 15 patients from the CABG group and 12 patients from the PCI group died (P=0.33), but the rate of MACE was higher in the PCI group (31 vs. 20%, P<0.01). Receiver operating curve analysis and univariate Cox regression analysis indicated that SS and cSS have prognostic value in the CABG group, but not in the PCI group. In the CABG group, SS and cSS showed significant discriminative power for long-term mortality (for SS>33 sensitivity 73.3%, specificity 71.4% and for cSS>38.4 sensitivity 93.3%, specificity 58.3%) and for MACE (for SS>34.5 sensitivity 50%, specificity 81.4% and for cSS>43.5 sensitivity 66.7%, specificity 73.8%).

CONCLUSION

SS and cSS scores have prognostic value in STEMI patients with multivessel disease treated with CABG surgery. cSS may be superior to SS for prediction of long-term adverse events in CABG patients.

摘要

背景

基线SYNTAX（SS）评分和临床SYNTAX（cSS）评分的预后价值已在不同的冠心病患者群体中得到证实。然而，在ST段抬高型心肌梗死（STEMI）合并多支血管病变的患者中，尚未对它们的预后价值进行比较。

方法

回顾性招募因STEMI接受直接经皮冠状动脉介入治疗（PCI）且罪犯血管以外至少有一处关键病变的患者。根据病历和血管造影计算SS和cSS，并在冠状动脉旁路移植术（CABG）组和PCI组中进行比较。长期主要不良心脏事件（MACE）定义为死亡、再梗死和靶血管血运重建。

结果

共分析了460例患者（CABG组214例，PCI组246例）。与PCI组相比，CABG组的基线SS和cSS显著更高（分别为30.1±6.7 vs. 22.5±5.6；P<0.01和41.4±21.2 vs. 27.2±15.9；P<0.01）。在32±8个月的随访期内，CABG组有15例患者死亡，PCI组有12例患者死亡（P=0.33），但PCI组的MACE发生率更高（31% vs. 20%，P<0.01）。受试者工作特征曲线分析和单因素Cox回归分析表明，SS和cSS在CABG组中有预后价值，但在PCI组中没有。在CABG组中，SS和cSS对长期死亡率（SS>33时，敏感性73.3%，特异性71.4%；cSS>38.4时，敏感性93.3%，特异性58.3%）和MACE（SS>34.5时，敏感性5%，特异性81.4%；cSS>43.5时，敏感性66.7%，特异性73.8%）显示出显著的鉴别能力。