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目的:评价SYNTAX积分Ⅱ(SYNTAX score Ⅱ,SS-Ⅱ)对冠状动脉3支病变患者,经皮冠状动脉介入治疗后5年死亡率的预测意义。方法:连续入选2007年1月至2008年12月,北京安贞医院心内科,经冠状动脉造影明确为3支病变且需行经皮冠状动脉介入治疗(PCI)治疗的患者共573例,进行回顾性研究。根据冠状动脉造影结果并结合临床因素计算患者的SS-Ⅱ,根据SS-Ⅱ数值的三分位法将患者进行分组:SS-Ⅱ低分组(0~20)、中分组(21~31)和高分组(≥32)。主要终点是术后5年全因死亡率。用Kaplan–Meier法进行生存分析,用Cox比例风险模型进行单因素、多因素分析,评价SS-Ⅱ预测PCI术后预后的价值。结果:全部入选患者SS-Ⅱ为(27.6±9.0)分。5年的全因死亡率为4.4%,在SSⅡ低分组、中分组和高分组患者中分别为1.6%、3.2%和8.6%,差异有统计学意义(P=0.003)。心源性死亡率在三组中的差异也有统计学意义(分别为0.5%、1.9%和5.2%,P=0.014),而非心源性死亡率的差异无统计学意义。校正其他可能混杂因素后,SS-Ⅱ是冠状动脉3支病变PCI术后5年死亡率的独立预测因素(HR=2.45,95%CI 1.38~4.36,P=0.002)。随SS-Ⅱ增加,患者PCI术后5年心肌梗死、再次血运重建和MACCE发生率也升高,差异均有统计学意义。5年脑卒中发生率尽管随SS-Ⅱ增加而升高,但差异无统计学意义。结论:SS-Ⅱ是冠心病3支病变患者PCI术后5年死亡率的独立预测因素,临床上可为复杂冠心病患者介入治疗提供一种危险分层工具。
Objective: To evaluate the predictive value of SYNTAX score Ⅱ (SS-Ⅱ) on 5-year mortality after coronary intervention in 3 patients with coronary artery disease. Methods: From January 2007 to December 2008, 573 consecutive patients who underwent coronary angiography in 3 patients with coronary artery angiography undergoing percutaneous coronary intervention (PCI) were enrolled in this study. Sexual research. According to coronary angiography and clinical factors in patients with SS-Ⅱ, according to SS-Ⅱ value of the tertile patients were divided into: SS-Ⅱ low group (0-20), the middle group (21-31) and High score group (≥32). The primary endpoint was all-cause 5-year mortality after surgery. Survival analysis was performed by Kaplan-Meier method. Univariate and multivariate analyzes were performed using the Cox proportional hazards model to evaluate the value of SS-II in prediction of prognosis after PCI. Results: All SS-Ⅱ patients were (27.6 ± 9.0) points. The 5-year all-cause mortality rate was 4.4%, which was 1.6%, 3.2% and 8.6% in the SSII low, middle and high group patients, respectively. The difference was statistically significant (P = 0.003). The difference in cardiac mortality was also statistically significant among the three groups (0.5%, 1.9% and 5.2%, respectively, P = 0.014), while there was no statistically significant difference in non-cardiac mortality. After adjusting for other possible confounders, SS-II was an independent predictor of 5-year mortality after 3-vessel coronary artery disease (HR = 2.45, 95% CI 1.38-4.46, P = 0.002). With the increase of SS-II, the incidence of myocardial infarction, re-revascularization and MACCE in PCI patients after 5 years of PCI also increased, with statistical significance. Although the incidence of stroke at 5 years increased with the increase of SS-Ⅱ, the difference was not statistically significant. Conclusion: SS-Ⅱ is an independent predictor of 5-year mortality after PCI in 3 patients with coronary artery disease. It provides a risk stratification tool for the interventional treatment of patients with complex coronary artery disease.