Objective: To investigate the predictive value of SYNTAX-Ⅱ score on long term prognosis of patients diagnosed with chronic total occlusion (CTO) and received percutaneous coronary intervention (PCI). Methods: Patients undergoing CTO-PCI in Fuwai hospital from January 2010 to December 2013 were enrolled in this retrospective analysis. The SYNTAX-Ⅱ score of the patients was calculated. According to SYNTAX-Ⅱ score tertiles, patients were stratified as follows: SYNTAX-Ⅱ≤20, 20<SYNTAX-Ⅱ≤27, SYNTAX-Ⅱ>27. Primary endpoint was major adverse cardiac events (MACCE), including all-cause death, myocardial infarction, stroke and any revascularization. Secondary endpoints included stent thrombosis, heart failure and target lesion failure (TLF). Patients were followed up by outpatient visit or telephone call at 1 month, 6 months and 1 year after PCI, and annually up to 5 years. Multivariate Cox regression model was used to analyze the independent risk factors of all-cause death in patients undergoing CTO-PCI. The predictive value of SYNTAX score with SYNTAX-Ⅱ score for all-cause death was evaluated by the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Results: A total of 2 391 patients with CTO and received PCI were enrolled in this study. The mean age was (57.0±10.5) years, 1 994 (83.40%) patients were male. There were 802 patients in lower tertile group (SYNTAX-Ⅱ≤20), 798 patients in intermediate group (20<SYNTAX-Ⅱ≤27) and 791 patients in upper tertile group (SYNTAX-Ⅱ>27). At the end of 5-year follow-up, the loss to follow-up rate of the three groups was 9.10%(73/802), 10.78%(86/798)and 8.85%(70/791), respectively. The rate of all-cause mortality (1.78% (13/729) vs. 3.65% (26/712) vs. 9.02% (65/721), P<0.001), cardiac death (1.37% (10/729) vs. 2.11% (15/712) vs. 4.85% (35/721), P<0.001), target vessel myocardial infarctions (4.25% (31/729) vs. 4.49% (32/712) vs. 7.07% (51/721), P=0.03), probable stent thrombosis (1.51% (11/729) vs. 2.81% (20/712) vs. 3.61% (26/721), P=0.04) and heart failure (1.78% (13/729) vs. 1.97% (14/712) vs. 5.41% (39/721), P<0.001) increased in proportion to increasing SYNTAX-Ⅱ score (all P<0.05). Multivariable Cox regression analysis indicated that female (HR=2.05, 95%CI 1.12-3.73, P=0.01), left ventricular ejection fraction (HR=0.97, 95%CI 0.95-1.00, P=0.05) and SYNTAX-Ⅱ score (HR=1.07, 95%CI 1.02-1.11,P=0.01) were independent predictors for all-cause mortality in patients undergoing CTO-PCI. The predicted value of the SYNTAX-Ⅱ score for all-cause death was significantly higher than the SYNTAX score (AUC 0.71 vs. 0.60, P=0.003). Conclusion: For CTO patients who underwent percutaneous coronary intervention, SYNTAX-Ⅱ score is an independent predictor for 5-year all-cause death, and SYNTAX-Ⅱ serves as an important predictor for all-cause death in these patients.
目的： 探讨SYNTAX-Ⅱ评分对接受经皮冠状动脉介入治疗（PCI）的冠状动脉慢性完全闭塞（CTO）病变患者的远期预后的预测价值。 方法： 本研究为回顾性研究。入选2010年1月至2013年12月于中国医学科学院阜外医院接受PCI治疗且存在至少1处CTO病变的患者。计算纳入患者的SYNTAX-Ⅱ评分，依据SYNTAX-Ⅱ评分采用三分位数法将纳入患者分为3组，即SYNTAX-Ⅱ≤20、20<SYNTAX-Ⅱ≤27和SYNTAX-Ⅱ>27组。主要终点为主要不良心脑血管事件（MACCE），定义为包括全因死亡、心肌梗死、卒中和血运重建的复合事件。次要终点包括支架内血栓、心力衰竭和靶病变失败（TLF）。分别于术后1、6个月，1年对纳入患者进行门诊或电话随访，此后每年进行1次直至术后5年。比较3组PCI术后5年终点事件的发生率，使用多因素Cox回归模型分析CTO病变患者在PCI术后全因死亡的独立危险因素，绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），比较SYNTAX评分与SYNTAX-Ⅱ评分对全因死亡的预测能力。 结果： 共纳入2 391例接受PCI治疗的CTO病变患者，年龄（57.0±10.5）岁，其中男性1 994例（83.40%）。SYNTAX-Ⅱ≤20组802例，20<SYNTAX-Ⅱ≤27组798例，SYNTAX-Ⅱ>27组791例。5年随访结束时3组的失访率分别为9.10%（73/802）、10.78%（86/798）和8.85%（70/791）。在全因死亡［1.78%（13/729）比3.65%（26/712）比9.02%（65/721），P<0.001］、心原性死亡［1.37%（10/729）比2.11%（15/712）比4.85%（35/721），P<0.001］、靶血管心肌梗死［4.25%（31/729）比4.49%（32/712）比7.07%（51/721），P=0.03］、可能的支架内血栓［1.51%（11/729）比2.81%（20/712）比3.61%（26/721），P=0.04］、心力衰竭［1.78%（13/729）比1.97%（14/712）比5.41%（39/721），P<0.001］发生率方面，3组间比较差异均有统计学意义。多因素Cox回归分析结果显示，女性（HR=2.05，95%CI 1.12~3.73，P=0.01）、左心室射血分数（HR=0.97，95%CI 0.95~1.00，P=0.05）和SYNTAX Ⅱ评分（HR=1.07，95%CI 1.02~1.11，P=0.01）是冠状动脉CTO病变患者PCI术后5年全因死亡事件的独立影响因素。ROC曲线显示SYNTAX-Ⅱ评分对CTO病变患者PCI术后全因死亡的预测能力高于SYNTAX评分（AUC：0.71比0.60，P=0.003）。 结论： 在接受PCI治疗的CTO病变患者中，SYNTAX-Ⅱ评分是PCI术后5年全因死亡的独立危险因素，对PCI术后全因死亡风险具有一定预测价值。.