摘要
目的探讨SYNTAX积分和Gensini评分对急性ST段抬高心肌梗死（STEMI）患者远期预后的预测价值。方法采用回顾性分析,连续入选2008年1月1日至2009年12月31日因STEMI收入北京大学第三医院心脏重症监护室,经皮冠状动脉介入治疗（PCI）并存活出院的患者共178例,计算SYNTAX积分和Gensini评分,按三分类法将患者分为3组：SYNTAX积分低分组SSlow〈10分（49例）、中分组10分≤SSmid〈18分（69例）、高分组SShigh≥18分（60例）;Gensini评分低分组GSlow〈41分（59例）、中分组41分≤GSmid〈64分（65例）、高分组GShigh≥64分（54例）。随访其主要不良心血管事件（major adverse cardiac events,MACE）,包括全因死亡、非致命性心肌梗死、再次血运重建、再次因心脏病住院的发生率,平均随访（4.7±0.5）年。结果 SYNTAX积分低分、中分及高分组的MACE发生率分别是18.4%、21.7%和45.0%,组间比较差异有显著统计学意义（P=0.004）。Gensini评分低分、中分及高分组的MACE发生率分别是20.3%、33.8%和33.3%,组间比较差异无统计学意义（P=0.186）。Cox多因素分析显示,SYNTAX积分是术后5年发生MACE的独立预测因子（P=0.037）,以高分组为参照,中分组发生MACE的风险显著降低（HR 0.42,95%CI 0.21~0.84,P=0.015）;而Gensini评分对远期预后无预测价值。结论 SYNTAX积分是STEMI患者远期发生MACE的独立预测因子,而Gensini评分对STEMI患者远期MACE发生率无预测价值。
Objective To investigate the predictive value of the SYNTAX score and Gensini score for long-term clinical outcomes in patients with acute ST-segment elevation myocardial infarction. Methods Retrospectively analyzed consecutive series of patients diagnosed with acute STEMI and treated with PCI who enrolled in Peking University Third Hospital Cardiac Intensive Care Unit from January 2008 to December2009,and survived to hospital discharge. The study enrolled 178 cases,and calculate the SYNTAX score and Gensini score. Tertiles for SYNTAX score and Gensini score were defined SSlow〈 10（ n = 49）,10≤SSmid〈 18（ n = 69）,SShigh≥18（ n = 60）,GSlow〈 41（ n = 59）,41 ≤ GSmid〈 64（ n = 65）,GShigh≥64（ n = 54）,respectively. The average follow-up time was 4. 7 ± 0. 5 years. The primary endpoint was major adverse cardiac events（ MACE）, including all-cause death, non-fatal myocardial infarction, repeat revascularization,and hospitalization due to heart disease. Results The rate of MACE in SYNTAX score groups was 18. 4% in the low,21. 7% in the intermedian,,45. 0% in the high（ P = 0. 004）. The rate of MACE in Gensini score groups was 20. 3% in the low,33. 8% in the intermedian,33. 3% in the high（ P =0. 186）. The rate of MACE in the intermedian is higher than in the high. Multivariate COX regression analysis demonstrated that the SYNTAX score independently predicted the rate of 5-year MACE in patients with STEMI（ P = 0. 037）. After adjusting SShighlevel as a reference point,MACE was found significant for SSmid（ HR 0. 42,95% CI 0. 21-0. 84,P = 0. 015）. And the Gensini score had no predictive value for 5-year MACE. Conclusions The SYNTAX score was an independent risk factor for long-term impact on MACE in patients with STEMI,but the Gensini score had no ability of predicting long-term clinical outcomes in patients with STEMI.
出处
《中国介入心脏病学杂志》
2014年第12期755-760,共6页
Chinese Journal of Interventional Cardiology
基金
国家自然科学基金(81300076)
