天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (7): 641-646.doi: 10.11958/20193145

• 临床研究 • 上一篇    下一篇

不同SYNTAX评分对冠状动脉旁路移植术后患者临床结局预测价值的比较

张紫玥1 ，刘玉洁2△，张颖2 ，周伽2   

  1. 1 天津医科大学胸科临床学院（邮编 300222）；2 天津市胸科医院心内四科
  • 收稿日期:2019-10-21 修回日期:2020-04-29 出版日期:2020-07-15 发布日期:2020-07-16
  • 作者简介:张紫玥（1994），女，硕士在读，主要从事心血管疾病方面研究

Comparison of the predictive values of different SYNTAX scores on the clinical outcome of patients after coronary artery bypass grafting

ZHANG Zi-yue1 , LIU Yu-jie2△, ZHANG Ying2 , ZHOU Jia2   

  1. 1 Thoracic Clinical College, Tianjin Medical University, Tianjin 300222, China; 2 The Forth Department of Cardiology, Tianjin Chest Hospital
  • Received:2019-10-21 Revised:2020-04-29 Published:2020-07-15 Online:2020-07-16

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摘要： 目的 探讨SYNTAX评分（SS）及SYNTAX评分Ⅱ（SS-Ⅱ）对冠状动脉旁路移植术（CABG）后患者长期临 床结局的预测价值。方法 连续纳入行CABG的符合标准的患者308例，分别计算SS及SS-Ⅱ，根据三分位数法，将 患者分为低、中、高分组，随访患者的主要不良心血管事件（MACE）。采用Kaplan-Meier生存分析、受试者工作特征 曲线及Cox回归分析，评价两种评分对CABG术后MACE预测的准确性。结果 中位随访期为63个月，MACE发生 率为30.5%。按SS和SS-Ⅱ分组，各组间MACE、再次血运重建、非致死性心肌梗死事件发生率差异均有统计学意义 （均P＜0.01）。SS及SS-Ⅱ低、中、高分组患者累积无MACE生存率差异有统计学意义（均P＜0.01）。SS及SS-Ⅱ是 预测MACE的可靠工具（AUC分别为0.664和0.751），且SS-Ⅱ对MACE的预测效能优于SS（Z=2.296，P＜0.05）。多因 素 Cox 回归分析显示，SS（中、高分组 HR 分别为 2.577 和 4.428）和 SS-Ⅱ（中、高分组 HR 分别为 2.343 和 5.108）是 MACE的危险因素。结论 SS及SS-Ⅱ均与CABG术后MACE有关，是评估因冠心病行CABG治疗患者远期预后的 预测指标。SS-Ⅱ对MACE的预测价值优于SS。

关键词: 冠心病, 预后, 冠状动脉旁路移植术, SYNTAX评分, SYNTAX评分Ⅱ, 主要不良心血管事件

Abstract: Objective To evaluate the predictive values of SYNTAX score (SS) and SYNTAX score Ⅱ (SS-Ⅱ) for the long-term outcomes of patients after coronary artery bypass grafting (CABG). Methods Data of 308 consecutive patients underwent CABG were collected in this study. The SS and SS-Ⅱ scores were calculated for each patient. Patients were stratified into low, middle and high score groups according to the tertiles of SS and SS-Ⅱ. The major adverse cardiovascular events (MACE) were followed up for patients. Kaplan-Meier was used for survival analysis. ROC curve and Cox regression analysis were used to evaluate the predictive values of SS and SS-Ⅱ for MACE. Results At a median follow-up of 63 months, the cumulative incidence of MACE was 30.5%. According to either SS or SS-Ⅱ, there were significant differences in MACE, repeat revascularization and non-fatal myocardial infarction between the three groups (P＜0.01). There were significant differences in the cumulative survival rates of non-MACE between three groups (P＜0.01). SS (AUC=0.664) and SS-Ⅱ (AUC=0.751) were reliable predictors of MACE. The predictive effect of SS-Ⅱ for MACE was significantly higher than that of SS (Z=2.296，P＜0.05). Multivariate Cox regression analysis showed that SS (HR 2.577 for the middle group; HR 4.428 for the high group) and SS-Ⅱ (HR 2.343 for the middle group; HR 5.108 for the high group) were risk factors for MACE. Conclusion Both SS and SS-Ⅱ are correlated with MACE in patients after CABG, and they are predictors for evaluating the long-term prognosis of patients with coronary heart disease treated with CABG. The predictive value of SS-Ⅱ for MACE is better than that of SS.

Key words: coronary disease, prognosis, coronary artery bypass, SYNTAX score, SYNTAX score Ⅱ, major adverse cardiovascular events