SYNTAX 评分与不稳定型心绞痛患者长期结局的相关性：一项单中心回顾性研究。
The association between SYNTAX score and long-term outcomes in patients with unstable angina pectoris: a single-centre retrospective study.
机构信息
Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Rd. Yong'an, XiCheng District, Beijing, 100050, China.
Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
出版信息
BMC Cardiovasc Disord. 2022 Apr 7;22(1):155. doi: 10.1186/s12872-022-02604-x.
BACKGROUND
The SYNTAX score affects clinical outcomes in early studies. However, the prognostic value of the SYNTAX Score for long-term outcomes and differences by SYNTAX score risk stratification in long-term prognosis between medical therapy and percutaneous coronary intervention (PCI) in patients with unstable angina pectoris (UAP) are not well known in the era of new generation drug-eluting stents and medication.
METHODS
In this single-centre retrospective study, a total of 2364 patients with UAP from January 2014 to June 2017 at Beijing Friendship Hospital were enrolled. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), including all-cause death, cardiac death, nonfatal myocardial infarction and stroke at least 2 years after discharge.
RESULTS
In this study, 1695 patients had low SYNTAX scores ([Formula: see text]), 432 patients had medium SYNTAX scores (23-32), 237 patients had high SYNTAX scores (≥ 33), 1018 received medical therapy, and 1346 patients underwent PCI. Long-term MACEs occurred in 95 patients during the 3.38 ± 0.99-year follow-up. Compared to the medical therapy group, the PCI group showed lower MACEs and cardiac death in patients with high SYNTAX scores (7.4% vs. 16.7%, P = 0.048; 3.7% vs. 14.6%, P = 0.004) but no reduction in patients with low and medium SYNTAX scores. Cox multivariate regression analysis showed that advanced age, diabetes mellitus, left ventricular ejection fraction (LVEF), hs-CRP and high SYNTAX score were independent predictors for MACEs in the medical therapy group (P < 0.05), whereas chronic kidney disease (CKD) and LVEF were predictors of MACEs in the PCI group.
CONCLUSIONS
Compared to medical therapy, PCI could only significantly reduce long-term MACEs and cardiac death for patients with high SYNTAX scores but not for patients with low and medium SYNTAX scores. A high SYNTAX score could predict long-term MACEs for UAP patients in the medical therapy group but not in the PCI group.
背景
SYNTAX 评分在早期研究中影响临床结局。然而，在新代药物洗脱支架和药物治疗时代，SYNTAX 评分对不稳定型心绞痛（UAP）患者长期预后的长期预后和经 SYNTAX 评分风险分层的经皮冠状动脉介入治疗（PCI）之间的差异的预后价值尚不清楚。
方法
本研究为单中心回顾性研究，共纳入 2014 年 1 月至 2017 年 6 月在北京友谊医院就诊的 2364 例 UAP 患者。主要终点是复合主要不良心血管事件（MACEs），包括出院后至少 2 年内全因死亡、心脏死亡、非致死性心肌梗死和卒中等。
结果
在这项研究中，1695 例患者 SYNTAX 评分较低（[公式：见正文]），432 例患者 SYNTAX 评分中等（23-32），237 例患者 SYNTAX 评分较高（≥33），1018 例接受药物治疗，1346 例患者接受 PCI。在 3.38±0.99 年的随访中，95 例患者发生长期 MACEs。与药物治疗组相比，SYNTAX 评分较高的 PCI 组患者的 MACEs 和心脏死亡率较低（7.4%比 16.7%，P=0.048；3.7%比 14.6%，P=0.004），但在 SYNTAX 评分较低和中等的患者中没有降低。Cox 多变量回归分析显示，高龄、糖尿病、左心室射血分数（LVEF）、高敏 C 反应蛋白（hs-CRP）和高 SYNTAX 评分是药物治疗组 MACEs 的独立预测因子（P<0.05），而慢性肾脏病（CKD）和 LVEF 是 PCI 组 MACEs 的预测因子。
结论
与药物治疗相比，PCI 仅能显著降低 SYNTAX 评分较高患者的长期 MACEs 和心脏死亡，但不能降低 SYNTAX 评分较低和中等患者的 MACEs。高 SYNTAX 评分可预测药物治疗组 UAP 患者的长期 MACEs，但不能预测 PCI 组患者的 MACEs。
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