CAJ | 학술논문

目的：以残余 SYNTAX 积分(rSS)定量评价不完全血运重建,探讨其对多支病变患者行经皮冠脉介入(PCI)治疗的远期预后评价。方法入选2010年1月至2011年6月在天津胸科医院经冠状动脉造影证实为多支病变并行 PCI 治疗患者653例。根据 PCI 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 rSS 分为： rSS≤4(207例)；4＜ rSS≤8(224例)；rSS ＞8(177例)。随访3~4年终点事件发生率。结果653例患者中失访104例,与 rSS≤4组和4＜ rSS≤8组比较,rSS ＞8组 MACCE 发生率(χ2=15.347,P ＜0.05)、心原性死亡率(χ2=7.383,P ＜0.05)、再次血运重建率(χ2=6.485,P ＜0.05)均明显升高,全因死亡率也明显增高(χ2=7.742,P ＜0.05)。 Kaplan-Meier 生存分析显示,rSS ＞8组患者长期无事件生存率明显低于 rSS≤4和4＜ rSS≤8两组患者(χ2=7.742,P =0.012)。结论残余 SYNTAX 积分可定量评价不完全血运重建,是 PCI 术后远期预后的预测因子,并有助于再血管化的治疗策略选择。
목적：이잔여 SYNTAX 적분(rSS)정량평개불완전혈운중건,탐토기대다지병변환자행경피관맥개입(PCI)치료적원기예후평개。방법입선2010년1월지2011년6월재천진흉과의원경관상동맥조영증실위다지병변병행 PCI 치료환자653례。근거 PCI 술전화술후관상동맥조영결과계산 SYNTAX 적분화잔여 SYNTAX 적분。근거 rSS 분위： rSS≤4(207례)；4＜ rSS≤8(224례)；rSS ＞8(177례)。수방3~4년종점사건발생솔。결과653례환자중실방104례,여 rSS≤4조화4＜ rSS≤8조비교,rSS ＞8조 MACCE 발생솔(χ2=15.347,P ＜0.05)、심원성사망솔(χ2=7.383,P ＜0.05)、재차혈운중건솔(χ2=6.485,P ＜0.05)균명현승고,전인사망솔야명현증고(χ2=7.742,P ＜0.05)。 Kaplan-Meier 생존분석현시,rSS ＞8조환자장기무사건생존솔명현저우 rSS≤4화4＜ rSS≤8량조환자(χ2=7.742,P =0.012)。결론잔여 SYNTAX 적분가정량평개불완전혈운중건,시 PCI 술후원기예후적예측인자,병유조우재혈관화적치료책략선택。
Objective To quantitative evaluation of incomplete revascularization in patients undergoing percutaneous coronary intervention ( PCI) using the residual SYNTAX score ( rSS), and to investigate the prognostic impact of this score to predict long-term survival rate post PCI. Methods From January 2010 to June 2011, 653 patients with multivessel coronary artery disease underwent PCI were enrolled in this study. The SYNTAX score (SS) and rSS were calculated before and after PCI. According to rSS the patients were defined as: rSS ≤4 ( n = 207), 4 < rSS ≤8 ( n = 224), rSS > 8 ( n = 177), respectively. Major adverse cardiac cerebrovascular events ( MACCE) rates ( cardiac death, nonfatal myocardial infarction,revascularization and stroke) and all-cause mortality,were followed-up in 3 - 4 year. Results 104 out of 653 cases were lost to follow-up. MACCE rate of rSS > 8 group was significantly higher than that of both rSS≤4 group and 4 < rSS≤8 group (χ2 = 15. 347,P < 0. 05). All-cause mortality at 3 - 4 year was significantly increased in rSS > 8 group ( χ2 = 7. 742, P < 0. 05). Kaplan-Meier survival curves showed the survival rate in rSS > 8 group was significantly lower than which in both rSS≤4 group and 4 < rSS≤8 group (χ2 = 7. 742,P = 0. 012) . Conclusions The residual SYNTAX score is a useful criteria to quantitatively evaluate incomplete revascularization in patients undergoing PCI for multivessel coronary artery disease. It is a long-term prognosis post PCI predictor and contributes to revascularization strategy selection.