Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China.
BMC Cardiovasc Disord. 2020 May 6;20(1):213. doi: 10.1186/s12872-020-01490-5.
There is a paucity of evidence on the combination of the SYNTAX score II (SSII) and erythrocyte sedimentation rate (ESR) in assessing the long-term prognosis of patients with ST-elevated myocardial infarction (STEMI) and multivessel disease. The objective of this study was to investigate whether the ESR could enhance the predictive value of SSII on the long-term prognosis of STEMI patients.
A retrospective cohort study involving 483 STEMI and multivessel disease subjects receiving primary percutaneous coronary intervention was conducted. Major adverse cardiovascular events (MACE) included cardiovascular death, acute heart failure, recurrent myocardial infarction, revascularization, and nonfatal stroke. The predicted values of different models were estimated by a likelihood ratio test, Akaike's information criteria (AIC), receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
During the follow-up period of up to 52 months, both the SSII and ESR were independently associated with MACE (hazard ratio [HR] = 1.032, p < 0.001; and HR = 1.021, p < 0.001, respectively). The likelihood test indicated that ESR could improve the prognostic model containing SSII (p < 0.001), while the combined model of SSII and ESR attained a lower AIC (p < 0.001). The area under the ROC curve of the combined model containing SSII and ESR increased by 0.05 (p = 0.04) compared to that of the model with SSII alone. The net reclassification and integrated discrimination of the SSII alone model improved significantly with ESR (NRI = 0.0319, p < 0.001; IDI = 0.0334, p < 0.001).
The prognostic model containing SSII, which is an independent risk factor of MACE, had a significantly enhanced predictive probability with the addition of ESR.
在评估 ST 段抬高型心肌梗死（STEMI）和多支血管病变患者的长期预后时，SYNTAX 评分 II（SSII）和红细胞沉降率（ESR）联合应用的证据有限。本研究旨在探讨 ESR 是否可以提高 SSII 对 STEMI 患者长期预后的预测价值。
回顾性队列研究纳入 483 例接受直接经皮冠状动脉介入治疗的 STEMI 和多支血管病变患者。主要不良心血管事件（MACE）包括心血管死亡、急性心力衰竭、再发心肌梗死、血运重建和非致死性卒中。通过似然比检验、赤池信息量准则（AIC）、受试者工作特征（ROC）曲线、净重新分类改善（NRI）和综合判别改善（IDI）评估不同模型的预测值。
在最长 52 个月的随访期间，SSII 和 ESR 均与 MACE 独立相关（风险比[HR]分别为 1.032，p<0.001；和 HR 分别为 1.021，p<0.001）。似然检验表明，ESR 可改善包含 SSII 的预后模型（p<0.001），而包含 SSII 和 ESR 的联合模型的 AIC 更低（p<0.001）。包含 SSII 和 ESR 的联合模型的 ROC 曲线下面积较仅包含 SSII 的模型增加了 0.05（p=0.04）。SSII 单因素模型的净重新分类和综合判别明显随 ESR 改善（NRI=0.0319，p<0.001；IDI=0.0334，p<0.001）。
包含 SSII 的预后模型是 MACE 的独立危险因素，加入 ESR 后预测概率显著提高。
