目的 探讨SYNTAX Ⅱ积分对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者预后的预测价值。方法 采用回顾性分析方法,收集解放军总医院第三医学中心2014-01至2016-06确诊为急性STEMI,且行直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)的患者445例。每例患者用SYNTAX Ⅱ积分系统评分,并记录发生主要不良心血管事件(major adverse cardiac events,MACE)的情况。根据评分将患者分为SYNTAX Ⅱ低分组和高分组。比较各临床因素对两组患者的影响;比较两组间终点事件的发生率和死亡率;分析急性STEMI患者全因死亡的影响因素和独立影响因素。结果 两组患者在年龄、性别、吸烟史、射血分数和Killip分级的比较中差异有统计学意义(P<0.05)。两组间终点事件发生率和死亡率比较,差异有统计学意义(P<0.05)。单因素分析显示:年龄、吸烟史、射血分数、血肌酐值、Killip 分级Ⅱ—Ⅳ级和SYNTAX Ⅱ积分是急性STEMI患者全因死亡的影响因素。COX回归分析表明:年龄(OR=1.696,95% CI 1.037～2.359)、射血分数(OR=0.810,95% CI 0.713～0.907)和SYNTAX Ⅱ积分(OR=1.309,95% CI 1.132～1.317)是急性STEMI患者全因死亡的独立危险因素。结论 SYNTAX Ⅱ积分是急性STEMI患者全因死亡的独立危险因素。随着SYNTAX Ⅱ积分的增加,MACE发生率增高,发生时间越早,其全因死亡率和心源性死亡率越高。
Abstract
Objective To investigate the predictive value of the SYNTAX score Ⅱ for clinical outcomes in patients with acute ST-segment elevation myocardial infarction.Methods A total of 445 acute STEMI patients receiving the PCI therapy within 12 hours between January 1, 2014 and June 30, 2016 were enrolled in this study. SYNTAX score Ⅱ was calculated,while major adverse cardiac events were recorded. These patients were divided into the low score group and the high score group. The effects of each clinical correlation factor were compared between the two groups of patients, so were the incidence and mortality of endpoint events. The influencing factors and independent influencing factors of all-cause mortality in patients with acute STEMI were analyzed.Results The difference between the two groups was statistically significant (P<0.05) in age, gender, smoking history, ejection fraction, Killip grade, and in incidence and mortality of endpoint events. Univariate analysis showed that age, smoking history, ejection fraction, serum creatinine, KillipⅡ-Ⅳ and SYNTAX scoreⅡ were factors that influenced the all-cause mortality of patients with acute STEMI. Cox regression analysis showed that age(OR=1.696,95% CI 1.037-2.359) , ejection fraction(OR=0.810,95% CI 0.713-0.907), SYNTAX scoreⅡ(OR=1.309,95% CI 1.132-1.317) were independent influencing factors of the all-cause mortality of patients with acute STEMI.Conclusions SYNTAX scoreⅡ is an independent risk factor for all-cause mortality in patients with acute STEMI. The higher SYNTAX scoreⅡ in patients with acute STEMI, the more chance of MACE, the earlier occurrence of MACE, the higher mortality.
关键词
SYNTAX Ⅱ积分 /
急性ST段抬高型心肌梗死 /
预后
Key words
SYNTAX score II /
ST-segment elevation myocardial infarction /
prognosis
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