SYNTAX评分对初次经皮冠状动脉介入治疗后住院预后的影响

Bangladesh Heart Journal Pub Date : 2018-12-28 DOI:10.3329/bhj.v33i2.39308

S. Islam, Afzalur Rahman, A. Chowdhury, Sayed Nasir Uddin, N. Kar, K. K. Karmakar, Mohammad Ullah Firoze, Mohammad Arifur Rahman, Monir Hossen Khan, Nure Alam Ashrafi, Muhammad Ruhul Amin, M. Arefin, F. Cader

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摘要

背景:目前关于SYNTAX评分对急性STEMI患者接受初级经皮冠状动脉介入治疗(PCI)住院结果的影响的数据有限。目的:评价SYNTAX评分对急性STEMI患者首次PCI术后院内预后的预测意义。方法:本队列研究于2015年9月- 2016年9月在孟加拉国达卡国立心血管疾病研究所心内科进行。42例接受首次PCI治疗的急性STEMI患者被纳入研究。但2例患者因首次PCI失败而被排除在研究之外。将患者分为两组:1组(低SYNTAX评分d " 22)和2组(高SYNTAX评分> 22)。所有患者的句法评分是根据首次PCI前的初始冠状动脉造影计算的。观察两组患者的住院情况。结果:在传统心血管危险因素中，II组糖尿病患病率明显高于I组(82.4% vs 34.8%， p Â 0.003)。血管造影显示，ⅰ组LAD动脉罪魁祸首病变最大(69.6% vs 17.6%)，ⅱ组RCA罪魁祸首病变最大(64.7% vs 21.7%)，两组间差异有统计学意义(P<0.05)。SYNTAX高评分组的TIMI 3较低(76.47% vs 91.3%， p Â 0.03)。SYNTAX评分高低在心律失常(2.5% vs 0%)、心源性休克(2.5% vs 0%)、心力衰竭(5%vs 2.5%)和死亡率(5%vs 0%)等并发症方面无显著差异。多因素logistic回归分析显示SYNTAX评分(OR = 5.95, p Â 0.001)是初次PCI患者住院预后的独立预测因子。初步PCI预后设置中SYNTEX评分的性能测试阳性预测值为83%。结论:SYNTAX评分是一个独立变量，可以预测急性STEMI患者接受初级PCI治疗的住院结果。孟加拉国心脏杂志2018;33(2): 121-125

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Impact of SYNTAX Score on In-hospital Outcome after Primary Percutaneous Coronary Intervention

Background: Limited contemporary data exist regarding the impact of SYNTAX score on in-hospital outcomes undergoing primary percutaneous coronary intervention(PCI) in acute STEMI patients. Objectives: To evaluate the significance of the SYNTAX score for predicting in- hospital outcome after primary PCI in patient with acute STEMI. Methods: This cohort study was conducted in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from September, 2015 to September, 2016. 42 patients with acute STEMI who underwent primary PCI were considered for the study. But 2 patients were excluded from the study due to failure of primary PCI. The patients were divided into two groups: Group I (low SYNTAX score d”22) and Group II (high Syntax score > 22). The Syntax score of all patients were calculated from an initial coronary angiogram before primary PCI. In-hospital outcome was observed in between two groups. Results: Among traditional cardiovascular risk factors diabetes was significantly more prevalent in the Group II than Group I ( 82.4% vs 34.8%, p Â 0.003). Angiographic profile revealed maximum (69.6% vs 17.6%) culprit lesion in LAD artery in Group I and maximum culprit lesion (64.7% vs 21.7%) in RCA in Group II, these were the statistically significant between Group I and Group II (P<0.05). The high SYNTAX score group had lower TIMI 3 (76.47% vs 91.3%, p Â 0.03) compared to the low SYNTAX score group. But there were no significant difference in complications as arrhythmia (2.5% vs 0%), cardiogenic shock (2.5% vs 0%), heart failure (5% vs 2.5%) and mortality (5%vs 0%) between high and low SYNTAX score. Multivariate logistic regression analysis revealed SYNTAX score (OR = 5.95, p Â 0.001) was an independent predictor of in-hospital outcome in patients under going primary PCI. Performance test of SYNTEX score in the setting of Primary PCI outcome showed positive predictive value 83%. Conclusions: SYNTAX score was an independent variable that can predict in-hospital outcomes of patients with acute STEMI undergoing primary PCI. Bangladesh Heart Journal 2018; 33(2) : 121-125

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Bangladesh Heart Journal

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