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术前SYNTAX评分对多支冠状动脉疾病患者冠状动脉旁路移植术后短期结局的影响。

Impact of preoperative SYNTAX Scores on short-term outcome following coronary artery bypass grafting surgery in the patients with multi-vessels coronary artery disease.

作者信息

Ramadan Bassem Adel, Zaki Mohamed Ahmed, Etman Wahid Gamal El Din, Agha Mohamed Mostafa, Sobhy Mohamed Ahmed, Hassanein Wael Mahmoud

机构信息

Faculty of Medicine, Alexandria University, Sultan Hussein Street, Al Khartoum Square, Alexandria, Egypt.

出版信息

Egypt Heart J. 2020 Jul 2;72(1):36. doi: 10.1186/s43044-020-00071-3.

Abstract

BACKGROUND

SYNTAX Scores I (SSI) assesses the complexity of CAD; SYNTAX Score II (SSII) uses both SSI and other clinical variables, in estimation of 4 years mortality following both coronary artery bypass grafting surgery (CABG) and percutaneous coronary intervention (PCI) and gives recommendations for the best revascularization strategy in a specific patient. Our aim is to investigate the impact of both SYNTAX Scores on short-term outcome following CABG.

RESULTS

Prospectively, we studied 150 patients with multi-vessels coronary artery disease, referred to perform, elective primary isolated CABG. All cases performed on pump CABG with aortic cross clamping, then followed up for 90 days postoperatively, for onset of mortality from all causes, myocardial infarction (MI), stroke, mediastinitis, and need for renal replacement therapy (RRT). SSI showed a statistically significant association with in-hospital and 90 days mortality, MI, and mediastinitis (P = < 0.001, 0.015, 0.045 respectively); SSII showed a statistically significant association with in-hospital mortality and 90 days mortality and need for renal replacement therapy (P = 0.007, 0.043, 0.012 respectively); SSI is independent risk factor for overall mortality (OR 1.192, 95% CI 1.018-1.396) (P = 0.029) and MI (OR 1.182, 95% CI 1.016-1.375).

CONCLUSIONS

SYNTAX Scores are good predictors of short-term outcome after CABG; increased SSI was associated with increased mortalities (in-hospital and total 90 days), MI and mediastinitis, increased SSII associated with increased mortalities (in-hospital and total 90 days), and need for RRT; SSI is independent risk factor for mortality and MI.

摘要

背景

SYNTAX评分I(SSI)评估冠状动脉疾病(CAD)的复杂性;SYNTAX评分II(SSII)使用SSI和其他临床变量,来估计冠状动脉旁路移植术(CABG)和经皮冠状动脉介入治疗(PCI)后4年的死亡率,并针对特定患者给出最佳血运重建策略的建议。我们的目的是研究SYNTAX评分对CABG术后短期结局的影响。

结果

我们前瞻性地研究了150例多支血管冠状动脉疾病患者,他们被推荐进行择期原发性孤立CABG。所有病例均在体外循环下进行CABG并使用主动脉交叉钳夹,然后术后随访90天,观察所有原因导致的死亡、心肌梗死(MI)、中风、纵隔炎以及肾脏替代治疗(RRT)的需求情况。SSI与住院期间及90天死亡率、MI和纵隔炎存在统计学显著关联(分别为P = <0.001、0.015、0.045);SSII与住院期间死亡率、90天死亡率以及肾脏替代治疗需求存在统计学显著关联(分别为P = 0.007、0.043、0.012);SSI是总体死亡率(OR 1.192,95%CI 1.018 - 1.396)(P = 0.029)和MI(OR 1.182,95%CI 1.016 - 1.375)的独立危险因素。

结论

SYNTAX评分是CABG术后短期结局的良好预测指标;SSI升高与死亡率增加(住院期间及90天总计)、MI和纵隔炎相关,SSII升高与死亡率增加(住院期间及90天总计)以及RRT需求相关;SSI是死亡率和MI的独立危险因素。

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