摘要
目的比较SYNTAX评分和残余SYNTAX(rSS)评分评估老年ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入治疗(PCI)术后不良预后的临床价值。方法收集2017年3月—2019年1月在洛阳市中医院确诊的STEMI并行PCI治疗的病人210例,根据是否发生主要不良心脑血管事件(MACCE)分为MACCE组和非MACCE组。比较两组临床资料,采用Logistic多因素回归分析影响MACCE发生的独立因素,Cox回归模型比较SYNTAX评分和rSS评分评估老年STEMI行PCI治疗术后不良预后的临床价值。结果MACCE组与非MACCE组相比,病人年龄、SYNTAX评分和rSS评分较高,高血压、脑梗死/短暂性脑缺血发作(TIA)、冠状动脉三支病变病人所占比例较高(P<0.05)。经Logistic多因素回归分析显示年龄、SYNTAX评分和rSS评分为STEMI病人PCI术后发生MACCE的独立影响因素。SYNTAX评分预测STEMI病人PCI术后发生MACCE灵敏度和特异度分别为72.3%、65.4%,曲线下面积为0.702,截断值32分;rSS评分预测STEMI病人PCI术后发生MACCE灵敏度和特异度分别为82.3%、74.6%,曲线下面积为0.824,截断值5分。rSS>5分组MACCE的发生率为37.2%、脑卒中发生率为14.0%和再次血运重建率为11.6%,均高于rSS≤5分组,全因死亡率和再发心肌梗死率组间比较差异无统计学意义。结论rSS>5分是老年STEMI行PCI治疗术后不良预后的独立危险因素,临床预测价值大于SYNTAX评分。
Objective To compare the clinical value of SYNTAX score and residual SYNTAX score in the evaluation of poor prognosis in elderly patients with ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods According to the occurrence of main adverse cardiovascular and cerebrovascular events(MACCE),two hundred and ten patients with STEMI after PCI were divided into MACCE group and non-MACCE group.The clinical data of the two groups were compared.Logistic multivariate regression was used to analyze the independent factors affecting the occurrence of MACCE,and Cox regression model was used to compare SYNTAX score and residual SYNTAX score to evaluate the clinical value of poor prognosis for elderly patients with STEMI after PCI.Results Compared with the non-MACCE group,average age,SYNTAX score,rSS score,the proportion of patients with hypertension,cerebral infarction/TIA,and coronary artery disease were higher in the MACCE group.Logistic multivariate regression analysis showed that age,SYNTAX score,and rSS score were independent factors influencing MACCE in STEMI patients after PCI.The SYNTAX score predicted the MACCE sensitivity and specificity of STEMI patients after PCI were 72.3%and 65.4%,respectively while the area under the curve was 0.702,and the cutoff value was 32.The rSS score predicted the MACCE sensitivity and specificity of STEMI patients after PCI were 82.3%and 74.6%,respectively while the area under the curve was 0.824,and the cutoff value was 5.The incidence of MACCE(37.2%),stroke(14.0%),respectively and rerevascularization(11.6%)in the rSS>5 score group were more than those in the rSS≤5 score group,there was no significant difference between the all-cause mortality rate and the rate of recurrent myocardial infarction.Conclusion rSS>5 score was an independent risk factor for poor prognosis in elderly STEMI patients after PCI,and its clinical predictive value was greater than SYNTAX score.
作者
符红军
赵聚博
邢国辉
高传玉
FU Hongjun;ZHAO Jubo;XING Guohui;GAO Chuanyu(Luoyang Hospital of Traditional Chinese Medicine,Luoyang 471000,Henan,China)
出处
《中西医结合心脑血管病杂志》
2021年第7期1129-1132,共4页
Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease
基金
河南省医学科技攻关计划项目(No.201602210)。
