摘要
目的研究心脏外科与介入治疗狭窄冠脉研究(SYNTAX)积分以及总体危险分类系统(global riskclassification,GRC)对左主干和(或)三支病变的冠心病患者经皮冠状动脉介入治疗(PCI)预后的预测作用及两者的比较。方法回顾性分析2007年1月—2008年12月在北京安贞医院心内科行PCI的左主干和(或)三支病变的冠心病患者共190例。根据冠状动脉造影结果计算SYNTAX积分,通过SYNTAX积分联合欧洲心脏手术危险评估系统(EuroSCORE)得到GRC。随访终点为主要不良心脑血管事件(MACCE),包括死亡、非致命性心肌梗死、再次血运重建、脑卒中。结果 SYNTAX积分低、中、高分组的MACCE发生率分别为9.1%、16.2%及30.9%,单因素及多因素分析结果均显示SYNTAX积分是MACCE的独立预测因子〔分别为:HR=2.15,95%CI(1.30,3.54),P=0.003;HR=2.07,95%CI(1.25,3.44),P=0.005〕。GRC低、中、高分组的MACCE发生率分别为17.8%、14.2%及46.1%,单因素及多因素分析结果均显示GRC是MACCE的独立预测因子〔分别为:HR=1.94,95%CI(1.22,3.50),P=0.007;HR=1.94,95%CI(1.15,3.27),P=0.013〕。SYNTAX积分ROC曲线下面积(AUROC)为0.667〔95%CI(0.564,0.770),P=0.004〕,GRC AUROC为0.617〔95%CI(0.512,0.736),P=0.046〕。结论SYNTAX积分和GRC对冠状动脉左主干和(或)三支病变患者行PCI治疗后的MACCE均有预测作用,GRC不优于SYNTAX积分。
Objective To assess the value of SYNTAX score and Global Risk Classification（GRC）in predicting major adverse cardiac and cerebrovascular events（MACCE）among patients with three-vessel and/or left-main coronary artery disease undergoing percutaneous coronary intervention（PCI）and furthermore compare the predictive ability between the two models. Methods A total of 190 patients with three-vessel and/or left-main coronary artery disease undergoing PCI with Cypher-select drug-eluting stent in Cardiology Department of Beijing Anzhen Hospital between January 2007 to December 2008 were enrolled.SYNTAX score and GRC were retrospectively calculated according to the angiography result.The clinical endpoint focused on MACCE,including death,nonfatal myocardial infarction（MI）,stroke,and repeat revascularization.Follow up was carried out by telephone or outpatient interview.The value of SYNTAX score and GRC to predict MACCE were studied respectively.Furthermore,area under the curve（AUC） was calculated to assess the difference between the predictive ablity of SYNTAX score and GRC. Results MACCE rates of low,intermediate,and high tertiles according to SYNTAX score were 9.1%,16.2% and 30.9%,respectively.Both univariate analysis and multivariate analysis showed that SYNTAX score was the independent predictor of MACCE（HR=2.15,95%CI（1.30,3.54）,P=0.003;HR=2.07,95%CI（1.25,3.44）,P=0.005）.MACCE rates of low,intermediate,and high tertiles according to GRC were 17.8%,14.2% and 46.1%,respectively.Both univariate analysis and multivariate analysis showed that GRC was the independent predictor of MACCE（HR=1.94,95%CI（1.22,3.50）,P=0.007;HR=1.94,95%CI（1.15,3.27）,P=0.013）.AUC of SYNTAX score was 0.667（95%CI（0.564,0.770）,P=0.004）,and AUC of GRC was 0.617（95%CI（0.512,0.736）,P=0.046）. Conclusion Both SYNTAX score and GRC could be independent risk predictors of MACCE among patients with three-vessel and/or left-main coronary artery disease undergoing PCI.GRC fail to show better predictive ability than SYNTAX score.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第1期36-39,共4页
Chinese General Practice
关键词
SYNTAX积分
GRC
经皮冠状动脉介入治疗
冠状动脉疾病
主要不良心脑血管事件
预测
SYNTAX score
Global risk classification
Percutaneous coronary intervention
Coronary artery disease
Major adverse cardiac and cerebrovascular events
Predictive
作者简介
通讯作者：陈方，100029北京市，首都医科大学附属北京安贞医院心内科，北京市心肺血管疾病研究所；E—mail：anzhenchenfang@163．com
