中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
2期
160-164
,共5页
李月平%史冬梅%赵迎新%刘宇扬%郭永和%杨清%成万钧%周玉杰
李月平%史鼕梅%趙迎新%劉宇颺%郭永和%楊清%成萬鈞%週玉傑
리월평%사동매%조영신%류우양%곽영화%양청%성만균%주옥걸
冠心病%SYNTAX积分%经皮冠状动脉介入%高龄%预后
冠心病%SYNTAX積分%經皮冠狀動脈介入%高齡%預後
관심병%SYNTAX적분%경피관상동맥개입%고령%예후
Coronary heart disease%SYNTAX score%Percutaneous coronary intervention%Octogenarian%Prognosis
目的 比较经皮冠状动脉TAXUS支架置入术与心脏外科手术协作研究(SYNTAX)积分、临床SYNTAX积分和残余SYNTAX积分对80岁以上高龄、多支血管病变患者经皮冠状动脉介入治疗术后1年主要不良心脑血管事件(MACCE)的预测价值.方法 回顾性分析从2010年1月至2012年1月因心绞痛接受经皮冠状动脉介入治疗的80岁及以上、多支血管病变的患者199例.根据经皮冠状动脉介入术前和术后冠状动脉造影结果计算SYNTAX积分和残余SYNTAX积分.根据SYNTAX积分,结合患者的年龄、左心室射血分数和肌酐清除率计算临床SYNTAX积分.根据3种积分的数值分别按照三分位法将患者分为低分组、中分组和高分组.随访1年,观察3种积分对MACCE(包括死亡、非致死性心肌梗死、再次血运重建、脑卒中)的预测作用.结果 199例中失访13例,SYNTAX积分低分组62例,中分组63例,高分组61例;残余SYNTAX积分低分组65例,中分组61例,高分组60例;临床SYNTAX积分低分组64例,中分组61例,高分组61例.SYNTAX积分低分、中分、高分组MACCE发生率分别为12.9％(8例),23.8％(15例)和41.0％(25例),高分组患者MACCE发生率明显高于低分组(P=0.001)和中分组(P=0.040);临床SYNTAX积分低分、中分、高分组MACCE发生率分别为17.2％(11例),21.3％(13例)和39.3％(24例),高分组MACCE发生率也明显高于低分组(P=0.009)和中分组(P=0.040);残余SYNTAX积分低分、中分、高分组主要MACCE发生率分别为20.0％(13例),29.5％(18例)和28.3％(17例),差异无统计学意义.COX-多因素回归分析显示SYNTAX积分(危险比为1.28,95％置信区间:1.08 ～1.56,P=0.01)及临床SYNTAX积分(危险比为1.07,95％置信区间:1.04～1.10,P=0.01)是MACCE的独立预测因素.受试者工作特征曲线分析,SYNTAX积分曲线下面积=0.710(95％置信区间:0.629 ～0.791,P=0.001);临床SYNTAX积分曲线下面积=0.687(95％置信区间:0.597～0.777,P=0.001),二者对MACCE均有预测价值,但是临床SYNTAX积分预测MACCE的准确性低于SYNTAX积分.结论 SYNTAX积分和临床SYNTAX积分对高龄、多支血管病变PCI治疗后1年MACCE有预测作用.虽然考虑了3个重要的临床因素,但是临床SYNTAX积分的预测作用并不优于SYNTAX积分.
目的 比較經皮冠狀動脈TAXUS支架置入術與心髒外科手術協作研究(SYNTAX)積分、臨床SYNTAX積分和殘餘SYNTAX積分對80歲以上高齡、多支血管病變患者經皮冠狀動脈介入治療術後1年主要不良心腦血管事件(MACCE)的預測價值.方法 迴顧性分析從2010年1月至2012年1月因心絞痛接受經皮冠狀動脈介入治療的80歲及以上、多支血管病變的患者199例.根據經皮冠狀動脈介入術前和術後冠狀動脈造影結果計算SYNTAX積分和殘餘SYNTAX積分.根據SYNTAX積分,結閤患者的年齡、左心室射血分數和肌酐清除率計算臨床SYNTAX積分.根據3種積分的數值分彆按照三分位法將患者分為低分組、中分組和高分組.隨訪1年,觀察3種積分對MACCE(包括死亡、非緻死性心肌梗死、再次血運重建、腦卒中)的預測作用.結果 199例中失訪13例,SYNTAX積分低分組62例,中分組63例,高分組61例;殘餘SYNTAX積分低分組65例,中分組61例,高分組60例;臨床SYNTAX積分低分組64例,中分組61例,高分組61例.SYNTAX積分低分、中分、高分組MACCE髮生率分彆為12.9％(8例),23.8％(15例)和41.0％(25例),高分組患者MACCE髮生率明顯高于低分組(P=0.001)和中分組(P=0.040);臨床SYNTAX積分低分、中分、高分組MACCE髮生率分彆為17.2％(11例),21.3％(13例)和39.3％(24例),高分組MACCE髮生率也明顯高于低分組(P=0.009)和中分組(P=0.040);殘餘SYNTAX積分低分、中分、高分組主要MACCE髮生率分彆為20.0％(13例),29.5％(18例)和28.3％(17例),差異無統計學意義.COX-多因素迴歸分析顯示SYNTAX積分(危險比為1.28,95％置信區間:1.08 ～1.56,P=0.01)及臨床SYNTAX積分(危險比為1.07,95％置信區間:1.04～1.10,P=0.01)是MACCE的獨立預測因素.受試者工作特徵麯線分析,SYNTAX積分麯線下麵積=0.710(95％置信區間:0.629 ～0.791,P=0.001);臨床SYNTAX積分麯線下麵積=0.687(95％置信區間:0.597～0.777,P=0.001),二者對MACCE均有預測價值,但是臨床SYNTAX積分預測MACCE的準確性低于SYNTAX積分.結論 SYNTAX積分和臨床SYNTAX積分對高齡、多支血管病變PCI治療後1年MACCE有預測作用.雖然攷慮瞭3箇重要的臨床因素,但是臨床SYNTAX積分的預測作用併不優于SYNTAX積分.
목적 비교경피관상동맥TAXUS지가치입술여심장외과수술협작연구(SYNTAX)적분、림상SYNTAX적분화잔여SYNTAX적분대80세이상고령、다지혈관병변환자경피관상동맥개입치료술후1년주요불양심뇌혈관사건(MACCE)적예측개치.방법 회고성분석종2010년1월지2012년1월인심교통접수경피관상동맥개입치료적80세급이상、다지혈관병변적환자199례.근거경피관상동맥개입술전화술후관상동맥조영결과계산SYNTAX적분화잔여SYNTAX적분.근거SYNTAX적분,결합환자적년령、좌심실사혈분수화기항청제솔계산림상SYNTAX적분.근거3충적분적수치분별안조삼분위법장환자분위저분조、중분조화고분조.수방1년,관찰3충적분대MACCE(포괄사망、비치사성심기경사、재차혈운중건、뇌졸중)적예측작용.결과 199례중실방13례,SYNTAX적분저분조62례,중분조63례,고분조61례;잔여SYNTAX적분저분조65례,중분조61례,고분조60례;림상SYNTAX적분저분조64례,중분조61례,고분조61례.SYNTAX적분저분、중분、고분조MACCE발생솔분별위12.9％(8례),23.8％(15례)화41.0％(25례),고분조환자MACCE발생솔명현고우저분조(P=0.001)화중분조(P=0.040);림상SYNTAX적분저분、중분、고분조MACCE발생솔분별위17.2％(11례),21.3％(13례)화39.3％(24례),고분조MACCE발생솔야명현고우저분조(P=0.009)화중분조(P=0.040);잔여SYNTAX적분저분、중분、고분조주요MACCE발생솔분별위20.0％(13례),29.5％(18례)화28.3％(17례),차이무통계학의의.COX-다인소회귀분석현시SYNTAX적분(위험비위1.28,95％치신구간:1.08 ～1.56,P=0.01)급림상SYNTAX적분(위험비위1.07,95％치신구간:1.04～1.10,P=0.01)시MACCE적독립예측인소.수시자공작특정곡선분석,SYNTAX적분곡선하면적=0.710(95％치신구간:0.629 ～0.791,P=0.001);림상SYNTAX적분곡선하면적=0.687(95％치신구간:0.597～0.777,P=0.001),이자대MACCE균유예측개치,단시림상SYNTAX적분예측MACCE적준학성저우SYNTAX적분.결론 SYNTAX적분화림상SYNTAX적분대고령、다지혈관병변PCI치료후1년MACCE유예측작용.수연고필료3개중요적림상인소,단시림상SYNTAX적분적예측작용병불우우SYNTAX적분.
Objective To investigate the ability of SYNTAX score (SS),clinical SYNTAX score (CSS) and residual SYNTAX score (RSS) regarding predicting one year major adverse cardiac and cerebrovascular events (MACCE) rates in octogenarian patients with multivessel coronary artery disease undergoing percutaneous coronary intervention(PCI).Methods The data of over 80 years old patients with multivessellesion undergoing PCI from January 2010 to January 2012 were retrospectively analyzed.The SS and RSS were calculated before and after PCI.The CSS was calculated using age,left ventricular ejection fraction (LVEF),creatinine clearance and SS.Tertiles for SS,CSS and RSS were defined as SSlow ≤ 13,13 ＜ SSmid ≤ 20 and SShigh ＞ 20,CSSlow 31,31 ＜ CSSmid ≤ 57and CSShigh ＞ 57,RSSlow ≤ 2,2 ＜ RSSmid ≤ 9 and RSShigh ＞ 9,respectively.Major adverse cardiovascular events (MACCE) rates (all-cause mortality,nonfatal myocardial infarction,target vessel revascularization and stroke)were followed-up at one year.Results Among 199 cases,13 cases were lost to follow-up,SSlow group had 62 cases,SSmid group had 63 cases,SShigh group had 61 cases; RSSIow group had 65 cases,RSSmid group had 61 cases,RSShigh group had 60 cases; CSSIow group had 64 cases,CSSmid group had 61 cases,CSShigh group had 61 cases.MACCE rate was 12.9％ (8 cases),23.8％ (15 cases) and 41.0％ (25 cases) in SSlow,SSmid and SShigh group,respectively.MACCE rate was 17.2％ (11 cases),21.3％ (13 cases) and 39.3％ (24 cases) in CSSlow,CSSmid and CSShigh group,respectively.MACCE rate was 20.0％ (13 cases),29.5％ (18 cases) and 28.3％ (17 cases)in RSSlow,RSSmid and RSShigh group,respectively.Patients in the high tertiles of SS and CSS experienced significant elevated MACCE compared with low and middle tertiles (all P ＜ 0.05).By multivariable Cox-regression analysis,SS(HR:1.28,95％CI:1.08-1.56,P=0.01) and CSS (HR:1.07,95％CI:1.04-1.10,P =0.01)were independent predictors of 1-year MACCE.Receiver-operator characteristic (ROC) curve analysis showed both SS[area under curve (AUC) =0.710 (95％ CI:0.629-0.791),P =0.001] and CSS [AUC =0.687,95％ CI:0.597-0.777,P =0.001] had predictive value of MACCE in octogenarian patients with multivessel coronary artery disease undergoing PCI.Conclusion SS and CSS are able to stratify risks for one year MACCE in octogenarian patients with multvessel coronary artery disease undergoing PCI.While considering the three important clinical factors,and CSS integral prediction effect is not better than that of the SYNTAX score.
