SYNTAX评分对冠状动脉支架内再狭窄患者预后的预测价值

周伯宁; 张昕; 宿永康; 焦阳; 沈建; 党子杰; 王继航; 李影; 王建; 刘赫男; 付振虹

doi:10.12435/j.issn.2095-5227.2024.126

摘要:

背景既往研究表明，SYNTAX评分可预测经皮冠状动脉介入治疗(percutaneous coronary intervention，PCI)术后患者的支架内再狭窄(in-stent restenosis，ISR)发生率。但是，对于SYNTAX评分与ISR患者长期预后的相关性研究较少。

目的探讨SYNTAX^ISR评分对PCI成功再血管化治疗ISR人群预后的影响。

方法本研究为回顾性队列研究，连续入选2016年12月— 2020年3月解放军总医院第一医学中心心脏介入中心PCI再血管化治疗的ISR患者，随访至2023年12月，采用多因素Cox回归分析评估SYNTAX^ISR评分和主要心血管不良事件(major adverse cardiovascular events，MACEs)之间的关系。对SYNTAX^ISR评分进行危险分层并绘制Kaplan-Meier曲线，使用log-rank检验评估各风险组之间的差异性。通过亚组分析，探究在不同亚组中SYNTAX^ISR评分与MACEs之间的相关性有无显著差异。通过时间依赖ROC 曲线评估SYNTAX ^ISR评分对MACEs的预测价值。

结果入选患者356例，平均年龄63.61 ± 9.82岁，女性68例(19.10%)，49例失访，随访率为86.3%。依据指南推荐的SYNTAX评分切点值(≤22分、23 ~ 32分、≥33分)，将受试者分为三组。随着SYNTAX^ISR评分的增加，MACEs的发生率增加。高SYNTAX^ISR评分组肌钙蛋白T和脑利钠肽更高，Mehran分型更容易表现为闭塞型。在多因素Cox回归分析中，SYNTAX^ISR评分与MACEs的发生独立关联(HR=1.039，P值0.000)。高危患者组(SYNTAX^ISR评分≥33分)MACEs发生率显著高于中危组(23分≤SYNTAX^ISR评分≤32分)(P值＜0.05)或低危组(SYNTAX^ISR评分≤22分)(P值0.000)。亚组分析进一步证明SYNTAX^ISR评分与MACEs的相关性稳定且显著。时间依赖的ROC曲线显示，在随访的6年中，每年的AUC值分别为0.636、0.620、0.648、0.601、0.635和0.619。

结论 SYNTAX评分是影响支架内再狭窄患者MACEs发生的独立危险因素。SYNTAX^ISR评分在评价MACEs方面具有一定的预测价值。

Abstract:

Background Previous studies suggest that SYNTAX score can predict the incidence of coronary in-stent restenosis in patients after percutaneous coronary intervention (PCI). Nevertheless, few studies focus on the correlation between SYNTAX score and long-term prognosis of patients with in-stent restenosis.

Objective To investigate the effect of SYNTAX^ISR score on the prognosis of patients with in-stent restenosis (ISR) and undergoing PCI.

Methods Patients with in-stent restenosis and undergoing coronary angiography in the Cardiology Department of Chinese PLA General Hospital from December 2016 to March 2020 were included in our retrospective cohort study, and they were followed up until December 2023. Multivariable Cox regression analysis was used to identify the association between SYNTAX^ISR score and major adverse cardiovascular events (MACEs). Kaplan-Meier curve and log-rank test were used to assess the differences among risk groups. Subgroup analysis was undertaken to investigate the consistency of the association between SYNTAX^ISR score and MACEs among different subgroups. Time-dependent receiver operating characteristic (ROC) curve was used to assess the capacity of SYNTAX^ISR score to predict MACEs.

Results Of the 356 cases, 68 cases were female, and the average age was 63.61 ± 9.82 years, 49 were lost to follow-up, and the follow-up rate was 86.3%. The subjects were divided into three groups according to the cutoff of SYNTAX^ISR score (≤22, 23-32, ≥33) recommended by guideline. The patients in the much higher SYNTAX^ISR score group would have higher cTnT and BNP. In the high SYNTAX^ISR score group, the Mehran classification tended to be total occlusion. Most importantly, the incidence of MACEs tended to be higher. In multivariate Cox regression analysis, SYNTAX^ISR score was significantly correlated with MACEs (HR=1.039, P＜0.001). The incidence of MACEs in high risk group (SYNTAX^ISR≥33) was significantly higher than that in intermediate risk group (23≤SYNTAX^ISR≤32) (P＜0.05) or low risk group (SYNTAX^ISR≤22) (P＜0.001). The subgroup analysis confirmed the significant association between SYNTAX^ISR score and MACEs. The AUC of time-dependent ROC curve from 1 to 6 years was 0.636, 0.620, 0.648, 0.601, 0.635 and 0.619, respectively.

Conclusion SYNTAX^ISR score is an independent risk factor for MACEs in patients with in-stent restenosis.

SYNTAX评分对冠状动脉支架内再狭窄患者预后的预测价值

Prognostic value of SYNTAX score for patients with coronary in-stent restenosis