Predictive Values Of SYNTAX Scores And Clinical SYNTAX Scores In Patients Undergoing Percutaneous Coronary Intervention For Complicated Coronary Artery Disease

Objective:To assess the value of SYNTAX score and clinical to predict major adverse cardiac and cerebrovascular events(MACCE)among patients with three vessel or left-main coronary artery disease undergoing percutaneous coronary intervention.By studying the predictive values of syntax score and clinical syntax score to predict major adverse cardiac and cerebrovascular events(MACCE)among patients with complicated coronary artery disease undergoing percutaneous coronary intervention.To compare the predictive values of SYNTAX Scores and clinical SYNTAX Scores in patients undergoing percutaneous coronary intervention for complicated coronary artery disease. Provide clinical basis for patients with three vessel or left main coronary artery disease to chose appropriate reascularization.Methods:A total of180patients with left main/three vessel lesion undergoing PCI in the first affiliated hospital of kunming medical university from March2009to August2010were retrospectively analyzed. SYNTAX score and clinical SYNTAX score were retrospectively calculated for every enrolled patient. MACCE were followed up by telephone.Our clinical endpoint focused on MACCE, a composite of death, nonfatal myocardial infarction(MI), stroke and repeat revascularizatio.Compare the value of SYNTAX score and clinical SYNTAX score to predict MACCE.Results:1. The enrolled180patients including140men and40women,men account for77.8%, women account for22.2%.The average age of patients was63.67±9.78years (ranging from38to83). The average left ventricular ejection fraction was(59.44±13.16)%. A history of myocardial infarction32account for17.8%, Hypertension116account for64.4%, diabetes47account for26.1%, hyperlipidemia 50account for27.8%, High uric acid hematic disease59account for32.7%,2have family history of CHD account for1.1%, a history of Cerebrovascular disease15account for8.3%. The history of smoking86,accounted for47.8%, the history of drinking36cases,account for20%. Chronic total occlusion5account for2.7%, simply left main lesion0, three-vessel disease159acccount for88.3%, left main coronary artery and Single lesion2account for1.1%, left main coronary artery and three-vessel disease10account for5.6%, left main coronary artery and two vessel disease9accounted for5%. Stable angina pectoris29account for11.1%,unstable angina pectoris130account for72.2%, Atypical coronary heart disease21account for11.7%. The average syntax score of patients was23.98±8.92(ranging from7to53). The average clinical syntax score of patients was28.45±15.99(ranging from7.77to91.76).2. In the enrolled180patients including130left dominance and50right dominance.3. Hg,RBC, PLT,WBC, TC, TG, HDL-c and Cr of low(<22), intermediate(23±32), and high(≥33)tertiles according to SYNTAX score were not statistically significant (P>0.05).LDL-c in low score group is hinger than high score group,LDL-c in intermediate score group Is higher than high score group,the difference have statistically significant(P<0.05).UA in low score group is lower than intermediate score group, intermediate score group lower than high score group, the difference have statistically significant(P<0.05).TB in low score group is higher than intermediate score group, intermediate score group higher than high score group, the difference have statistically significant(P<0.05).4. PLT,WBC, TC, TQ HDL-c and Cr of low(≤20.1), intermediate(20.2-29.6), and high(>29.7)tertiles according to clinical SYNTAX score were not statistically significant (P>0.05).RBC in low score group higher than intermediate score group,Hg in low score group is higher than intermediate score group and high score group, the difference have statistically significant(P<0.05). UA in low score group is lower than intermediate score group, intermediate score group lower than high score group, the difference have statistically significant(P<0.05).TB in low score group is higher than intermediate score group, intermediate score group higher than high score group, the difference have statistically significant(P<0.05).LDL-c in low score group is higher than intermediate score group, intermediate score group higher than high score group, the difference have statistically significant(P<0.05).5.36patients were observed to suffer from MACCE,accouting20%of the overall180patient.Stroke3, repeat revascularization20, nonfatal myocardial infarction8,death5.6. MACCE rates of low(≤22), intermediate(23-32), and high(≥33)tertiles according to SYNTAX score were15.7%.20%.32%respectively. The difference between intermediate score group and low score group was not statistically significant [HR=1.054,95%CI (0.321,3.456), P=0.931].The difference between high score group and low score group was statistically significant[HR=2.998,95%CI (1.097,8.193), P=0.032]. The difference between intermediate score group and high score group was statistically significant [HR=0.351,95%CI (0.137,0.899), P=0.029].This demonstrate that syntax score can pridict MACCE. SYNTAX score and diabetes mellitus were identified as an dependment pridictors of MACCE in Cox univariate analysis(P<0.05).7. MACCE rates of low(<20.1), intermediate(20.2±29.6), and high(≥29.7)tertiles according to clinical SYNTAX score were11%.15%.33%,respectively. The difference between intermediate score group and Low score group was not statistically significant[(HR=1.279,95%CI(0.519,3.148),P=0.593)]. The difference between high score group and low score group was statistically significant [HR=1.961,95%CI(0.772,4.986), P=0.041].The difference between intermediate score group and high score group was statistically significant[HR=0.652,95%CI(0.251,1.695), P=0.038]. This demonstrate thatclinical syntax score can pridict MACCE. Clinical SYNTAX score and diabetes mellitus were identified as an dependment pridictors of MACCE in Cox univariate analysis(P<0.05).8. The syntax score pridicted MACCE with an area under the receiver operator curve of0.66[P=0.008,95%CI (0.546,0.773)].The clinical syntax score pridicted MACCE with an area under the receiver operator cu rve of0.61[P=0.032,95%CI (0.447,0.818)]. Clinical SYNTAX score failed to show better predictive ability than the SYNTAX score in this group of patients.Conclusion:I. Both syntax score and clinical syntax score are independent predictor of MACCE for Complex coronary hearth disease patients after PCI. Both syntax score and clinical syntax score can predict the prognosis of patients with complex coronary heart disease after PCI.2. In spite of joined the age, left ventricular ejection fraction and kidney three important clinical information,Clinical SYNTAX score failed to show better predictive ability than the SYNTAX score in this group of patients.3. Diabetes is a independent predictor of MACCE for Complex coronary heart disease patients after PCI.4.The more serious coronary artery disease, the lower serum bilirubin,serum uric acid is higher.