SYNTAX积分和Gensini_省略_梗死患者远期心血管事件的预测价值_祖凌云

DOI10.3969/[e-mail]··SYNTAXGensiniST【】SYNTAXGensiniSTSTEMI。20081120091231STEMIPCI178SYNTAXGensini3SYNTAXSSlow＜1049、10≤SSmid＜1869、SShigh≥1860GensiniGSlow＜4159、41≤GSmid＜6465、GShigh≥6454。majoradversecardiaceventsMACE、、、4.7±0.5。SYNTAX、MACE18.4%、21.7%45.0%P=0.004。Gensini、MACE20.3%、33.8%33.3%P=0.186。CoxSYNTAX5MACEP=0.037MACEHＲ0.4295%CI0.21～0.84P=0.015Gensini。SYNTAXSTEMIMACEGensiniSTEMIMACE。【】STSYNTAXGensini【】Ｒ542.22ThepredictivevalueoftheSYNTAXscoreandgensiniscoreforlong-termclinicaloutcomesinpatientswithacuteST-segmentelevationmyocardialinfarctionZULing-yunGEHong-xiaGAOWei.DepartmentofCardiologyPekingUniversityThirdHospitalKeyLaboratoryofCardiovascularMolecularBiologyandＲegulatoryPeptidesMinistryofHealthKeyLaboratoryofMolecularCardiovascularSciencesMinistryo[e-mail]【Abstract】ObjectiveToinvestigatethepredictivevalueoftheSYNTAXscoreandGensiniscoreforlong-termclinicaloutcomesinpatientswithacuteST-segmentelevationmyocardialinfarction.MethodsＲetrospectivelyanalyzedconsecutiveseriesofpatientsdiagnosedwithacuteSTEMIandtreatedwithPCIwhoenrolledinPekingUniversityThirdHospitalCardiacIntensiveCareUnitfromJanuary2008toDecember2009andsurvivedtohospitaldischarge.Thestudyenrolled178casesandcalculatetheSYNTAXscoreandGensiniscore.TertilesforSYNTAXscoreandGensiniscoreweredefinedSSlow＜10n=4910≤SSmid＜18n=69SShigh≥18n=60GSlow＜41n=5941≤GSmid＜64n=65GShigh≥64n=54respectively.Theaveragefollow-uptimewas4.7±0.5years.TheprimaryendpointwasmajoradversecardiaceventsMACEincludingall-causedeathnon-fatalmyocardialinfarctionrepeatrevascularizationandhospitalizationduetoheartdisease.ＲesultsTherateofMACEinSYNTAXscore·557·2014122212ChinJInterventCardiolDecember2014Vol22No.12groupswas18.4%inthelow21.7%intheintermedian45.0%inthehighP=0.004.TherateofMACEinGensiniscoregroupswas20.3%inthelow33.8%intheintermedian33.3%inthehighP=0.186.TherateofMACEintheintermedianishigherthaninthehigh.MultivariateCOXregressionanalysisdemonstratedthattheSYNTAXscoreindependentlypredictedtherateof5-yearMACEinpatientswithSTEMIP=0.037.AfteradjustingSShighlevelasareferencepointMACEwasfoundsignificantforSSmidHＲ0.4295%CI0.21-0.84P=0.015.AndtheGensiniscorehadnopredictivevaluefor5-yearMACE.ConclusionsTheSYNTAXscorewasanindependentriskfactorforlong-termimpactonMACEinpatientswithSTEMIbuttheGensiniscorehadnoabilityofpredictinglong-termclinicaloutcomesinpatientswithSTEMI.【Keywords】AcutemyocardialinfarctionSYNTAXscoreGensiniscoreMajoradversecardiaceventsSYNTAXGensini。2009《》SYNTAXSYNTAXSYNTAXPCI1-4。SYNTAXSTSTEMI。SYNTAXSTEMIPCIGensini。1.20081120091231STEMIPCI178。130min222ST≥0.1mV≥0.2mV32TI412h5TIMIⅢ。1。2PCICABG。3。4。5。【2012】098。2.、、、、、、、、、low-densitylipoproteinLDL、high-densitylipoproteinHDL、T3。、MACE、、、2014127。3.PCISYNTAXGensini。SYNTAX≥1.5mm≥50%。Gensini5140～25%125%～49%250%～74%475%～89%890%～99%16100%3252.52.51.5、、、、、、1.00.5。。1SYNTAXSSlow＜1010≤SSmid＜18SShigh≥182GensiniGSlow＜4141≤GSmid＜64GShigh≥64。36。4.SPSS19.0。±z-score=-/·657·2014122212ChinJInterventCardiolDecember2014Vol22No.12MACEKaplan-MeierCox0.050.10HＲ95%CI。P＜0.05。1.1784022.5%35～9063.8±12.8。1。SYNTAXGensiniT3。KillipⅡ～ⅣSYNTAX3SYNTAXKillipⅡ。SYNTAX3。Gensini3LDLLDL。2.17873.9%、5430.3%、5530.9%、6938.8%。SYNTAXGensini2。3.4.7±0.5MACE5252/17829.2%MACE2.4±1.42323/5244.2%1515/521SYNTAXGensini3STEMIF/χ2PSYNTAX496960珋x±s58.2±11.163.4±12.569.0±12.710.6910.000b%918.41115.92033.36.2250.044a%1734.72029.02440.01.7340.420%2653.13550.73456.70.7950.458%510.257.2610.00.8260.383%2857.14260.92440.06.1180.047a%珋x±s58.9±9.555.6±8.751.6±10.27.8490.001bμmol/L珋x±s90.0±14.391.3±21.896.8±25.81.5530.215KillipⅡ～Ⅳ%48.21318.81728.38.0640.018ammol/L珋x±s7.35±6.248.85±19.208.17±10.480.1550.856LDLmmol/L珋x±s2.587±0.7342.908±0.9193.024±1.0603.0020.058HDLmmol/L珋x±s1.047±0.4750.966±0.4620.917±0.1971.4190.245T3%0057.2711.7－0.031aGensini596554珋x±s58.6±11.066.0±12.766.9±13.28.1190.000b%1220.31218.51629.62.3420.310%1728.82233.82240.71.7890.409%3050.83858.52750.01.0740.584%58.569.259.30.0350.983%3762.73350.82444.43.9460.139%珋x±s59.2±8.554.4±9.451.8±10.48.7270.000bμmol/L珋x±s86.5±19.294.8±18.497.2±26.23.7380.026aKillip≥Ⅱ%610.21320.01527.85.7110.058mmol/L珋x±s9.94±21.127.45±9.997.2±3.230.6580.519LDLmmol/L珋x±s2.637±0.7142.830±0.8783.127±1.1383.8310.024aHDLmmol/L珋x±s1.011±0.4610.974±0.4610.927±0.1890.6040.548T3%23.423.1814.8－0.034aSTEMISTLDLHDLaP＜0.05bP＜0.01·757·2014122212ChinJInterventCardiolDecember2014Vol22No.1228.8%。SYNTAXMACE。SYNTAX、、MACE20.4%、21.7%45.0%P=0.004MACE3P=0.005SYNTAXMACE。、3、、3。Gensini、、MACE20.3%、33.8%33.3%3。MACE3P=0.048GenesiniMACE。、、、、、3。4.STEMIPCIMACE、、、KillipⅡ～Ⅳ、T3SYNTAX。SYNTAXKaplan-Meier1。、、、、、、LDL、HDLGensini4。5.CoxP＜0.1、、、T3SYNTAXPCI2SYNTAX3STEMIχ2PSYNTAX496960%2244.92231.91016.710.3000.006a%1836.72840.6915.010.9130.004a%918.41927.64168.334.3520.000b%0034.346.7－0.178Gensini596554%2847.51929.2713.015.9340.000b%2237.32640.0713.011.7860.003b%915.32030.84074.143.8510.000b%23.434.623.7－1.000STEMISTaP＜0.05bP＜0.013SYNTAXGensini3MACEF/χ2PSY