Application Of SYNTAX Score Value In Unprotected Left Main Disease

Objective: To investigate the application value of the SYNTAX score in unprotected left main coronary artery disease.Methods:The study which was retrospective selected 172 cases from 2012 to 2014 in Cangzhou Central Hospital. All of them were accepted the coronary artery angiography and conformed to left coronary artery disease. In 172 cases, 8 patients were missed to follow. Selection criterion: The outcome of the patients’ coronary angiography was confirmed with the left main coronary artery disease, and the stenosis was greater than or equal to 50% of the extent, while there was no patency of the vascular bridge or its right to left good collateral circulation; the patients who treated with percutaneous coronary intervention were implanted drug-eluting stent. Exclusion criteria: The patients can not tolerance antiplatelet treatment; the patients with left main coronary artery disease due to reasons other than coronary atherosclerosis; Associated with cancer or chronic disease patients; the patients with a previous history of CABG or PCI operation.The patients were treated by percutaneous coronary intervention or coronary artery bypass graft surgery with rating results of coronary arteriography by SYNTAX score. All patients were followed up for 12 months and were observed whether they had the major adverse cardiovascular and cerebrovascular events(including all-cause mortality, target lesion revascularization, non fatal myocardial infarction, and non fatal cerebrovascular accident).Statistical analysis: Data were analyzed with SPSS13.0. Continuous data are expressed as means ± SD, and categorical data are expressed as percentages. Continuous data were used t test, and categorical data were used Chi-square test. Survival rate curve was used the Kaplan-Meier method, and checked by Log-rank. The multi-factor regression analysis was used Cox regression model. Differences were considered statistically significant at a p value<0.05.Results:1 Characteristics of baseline data: The differences between the two groups(PCI-DES group and CABG group) were not statistically significant in the clinical general aspects of the age, sex, hypertension, diabetes and smoking etc(P>0.05). The differences between the two groups were not statistically significant in the aspect of left ventricular ejection fraction, total cholesterol, low density lipoprotein, SYNTAX score etc(P>0.05).2 Coronary angiography: The study compared two groups of patients with unprotected left main coronary artery disease complicated with other vascular lesions. It shows there were no significant difference between PCI-DES group and CABG group in the aspect of single left main artery disease、with one artery disease、with two arteries disease and with threes arteries disease. On the site of lesion, although the number of PCI-DES patients with ostial lesion Significantly more than the number of patients with CABG(21.4% vs12.5%), but the difference was not statistically significant difference between the two groups(P>0.05). The same, the difference of body lesions and bifurcation lesions is still not statistically significant(P>0.05).3 The situation during the hospitalization: The PCI-DES group had no major adverse cardiovascular and cerebrovascular events, but the CABG group consisted of 3 patients with cardiac death and 1 patient with non lethal cerebral vascular events after operation. During hospitalization, the incidence of MACCE in CABG group higher than in PCI-DES group. The difference was statistically significant(P=0.04).4 Follow-up: Patients were followed up for 1 years. In the middle scores and low scores,the incidence of MACCE in PCI-DES group is similar to CABG group(P>0.05).In the high score group, target lesion revascularization rate in PCI-DES group was significantly higher than that in CABG group, but the difference was not statistically significant( P =0.062).The incidence of MACCE in PCI-DES group was significantly higher than that of CABG group,but there was no significant difference between two groups(P>0.05). In the PCI-DES group, patients with higher SYNTAX score had the higher incidence rate of MACCE in 1 years after operation,but the difference was statistically significant. In the CABG group, both the SYNTAX score, the difference in the incidence of MACCE was no statistical significance.Conclusion: SYNTAX score played a guiding role in the selection of revascularization mode for some patients with unprotected left main coronary artery disease. When the SYNTAX score<33, patients with unprotected left main coronary artery disease selected the clinical effect of PCI or CABG treatment is similar. When the SYNTAX score more than 33 points, CABG is the best revascularization method for patients with unprotected left main coronary artery disease. But the clinical effect of treatment of unprotected left main coronary artery lesions with rapamycin DES is not inferior to the CABG.