残余SYNTAX积分与冠心病患者经皮冠状动脉介入治疗术后运动耐量的关系
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摘要
目的:探讨通过残余SYNTAX积分(rSS)反映的不同血运重建程度的冠心病患者行经皮冠状动脉介入治疗(PCI)术后运动耐量的差异。方法:连续入选2011年1月至2018年1月通过冠状动脉造影明确诊断冠心病并行PCI,并在PCI后12个月之内完成心肺运动试验(CPET)的患者共95例。通过两种方式将患者分组:(1)依据r SS将患者进行分组,分为rSS=0分组(n=27), 0分8分组(n=28);(2)依据基础SYNTAX积分(bSS)将患者分组,由于所有患者的bSS均不超过32,故根据bSS将所有患者分为bSS≤22分组(n=70)和bSS>22分组(n=25)。比较不同组患者1年内CPET参数,包括反映运动耐量的峰值代谢当量(MET_(peak))、峰值代谢当量占预计值百分比(MET_(peak)%pred)、峰值耗氧量(VO_(2peak))、峰值耗氧量占预计值百分比(VO_(2peak)%pred)、无氧阈(AT)时VO_2等指标,反映通气功能的每分通气量(VE)、二氧化碳通气当量(VE/VCO2)等指标。结果:rSS分组中,rSS=0分、 0分8分三组患者反映运动耐量的MET_(peak)[(7.39±1.81) mets vs (6.96±1.66) mets vs (5.94±1.34) mets,P=0.005]、MET_(peak)%pred[(88.96±16.44)%vs (81.31±19.05)%vs(70.77±15.07)%,P=0.001]、AT时MET[(4.77±0.99)mets vs (4.73±0.96) mets vs (4.06±1.12) mets,P=0.018]、VO_(2peak)%pred[(83.27±16.24)%vs (80.71±16.57)%vs (72.77±12.71)%,P=0.040]、AT时VO_2[(16.72±3.48)ml/(min·kg) vs (16.58±3.34) ml/(min·kg) vs (14.36±3.87) ml/(min·kg),P=0.028],差异均有统计学意义;将三组间差异有统计学意义的参数三组进行LSD-t检验多重比较时,rSS=0分组和0分8分组比较差异均有统计学意义(P<0.05)。根据bSS分组中,bSS≤22分组和bSS>22分组患者的CPET相关参数差异均无统计学意义。结论:(1)接受PCI的患者,完全血运重建(rSS=0分组)患者与合理的不完全血运重建(0分8分组)的患者;(2)与bSS相比,rSS可更好地评价患者的运动耐量。
Objectives: The purpose of this study was to quantify the level of incomplete revascularization post percutaneous coronary intervention(PCI) by the residual SYNTAX score(rSS) and evaluate the association between rSS and exercise tolerance post PCI in patients with coronary atherosclerotic heart disease(CAD).Methods: We enrolled 95 CAD patients treated with PCI and completed CPET within 12 months after PCI treatment.The patients were divided into different subgroups according to residual SYNTAX score or baseline SYNTAX score(bSS):(1) according to residual SYNTAX score, patients were divided into rSS=0 group(n=27), 08 group(n=28);(2) according to baseline SYNTAX score, patients were divided into low bSS group(bSS≤22, n=70) and moderate bSS group(bSS>22, n=25). The CPET variables within 1 year, including ME_(Tpeak), ME_(Tpeak)%pred, MET at anaerobic threshold(AT), VO_(2 peak), VO_(2 peak)%pred, VO_2 at AT, were collected and compared.Results: Among rSS=0, 08 groups, there were statistical differences in ME_(Tpeak)([7.39±1.81] mets vs[6.96±1.66] mets vs [5.94±1.34] mets, P=0.005), ME_(Tpeak)%pred([88.96±16.44]% vs [81.31±19.05]% vs [70.77±15.07]%,P=0.001), MET at AT([4.77±0.99] mets vs [4.73±0.96] mets vs [4.06±1.12] mets, P=0.018), VO_(2 peak)%pred([83.27±16.24]%vs [80.71±16.57]% vs [72.77±12.71]%, P=0.040), VO_2 at AT([16.72±3.48] ml/(min?kg) vs [16.58±3.34] ml/(min?kg) vs[14.36±3.87] ml/(min?kg), P=0.028). There was no statistical difference in CPET variables between bSS≤22 group and bSS>22 group.Conclusions:(1) There is no significant difference in exercise tolerance between CR(rSS=0) and rICR( 0 8);(2) Residual SYNTAX score is superior to baseline SYNTAX score on reflecting exercise tolerance in CAD patients post PCI.
Objectives: The purpose of this study was to quantify the level of incomplete revascularization post percutaneous coronary intervention(PCI) by the residual SYNTAX score(rSS) and evaluate the association between rSS and exercise tolerance post PCI in patients with coronary atherosclerotic heart disease(CAD).Methods: We enrolled 95 CAD patients treated with PCI and completed CPET within 12 months after PCI treatment.The patients were divided into different subgroups according to residual SYNTAX score or baseline SYNTAX score(bSS):(1) according to residual SYNTAX score, patients were divided into rSS=0 group(n=27), 0
引文
[1] Hannan EL, Racz M, Holmes DR, et al. Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era[J]. Circulation, 2006, 113(20):2406-2412.DOI:10. 1161/CIRCULATIONAHA. 106.612267.
[2] Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden-results from the clinical outcomes utilizing revascularization and aggressive drug evaluation(COURAGE)trial nuclear substudy[J]. Circulation, 2008, 117(10):1283-1291. DOI:10. 1161/CIRCULATIONAHA. 107.743963.
[3] Hannan EL, Wu C, Walford G, et al. Incomplete revascularization in the era of drug-eluting stents:impact on adverse outcomes[J]. JACC Cardiovasc Interv, 2009, 2(1):17-25. DOI:10. 1016/j. jcin. 2008. 08.021.
[4] Kim YH, Park DW, Lee JY, et al. Impact of angiographic complete revascularization after drug-eluting stent implantation or coronary artery bypass graft surgery for multivessel coronary artery disease[J]. Circulation, 2011, 123(21):2373-2381. DOI:10. 1161/CIRCULATIONAHA. 110. 005041.
[5]高国峰,丰雷,赵延延,等.残余SYNTAX评分在中国冠心病介入患者中的应用价值研究[J].中国循环杂志,2018,33(2):117-122. DOI:10. 3969/j. issn. 1000-3614. 2018. 02. 004.
[6] De BB. Multivessel disease:from reasonably incomplete to functionally complete revascularization[J]. Circulation, 2012,125(21):2557. DOI:10. 1161/CIRCULATIONAHA. 112. 106872.
[7] Dauerman HL. Reasonable incomplete revascularization[J].Circulation, 2011, 123(21):2337-2340. DOI:10. 1161/CIRCULATIONAHA. 111.033126.
[8] Farooq V, Serruys PW, Bourantas CV, et al. Quantification of incomplete revascularization and its association with five-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery(SYNTAX)trial validation of the residual SYNTAX score[J]. Circulation, 2013, 128(2):141-151.DOI:10. 1161/CIRCULATIONAHA. 113. 001803.
[9] Xu B, Yang YJ, Han YL, et al. Validation of residual SYNTAX score with second-generation drug-eluting stents:one-year results from the prospective multicentre SEEDS study[J]. EuroIntervention, 2014,10(1):65-73. DOI:10. 4244/EIJV10I1A12.
[10] Witberg G, Lavi I, Assali A, et al. The incremental impact of residual SYNTAX score on long-term clinical outcomes in patients with multivessel coronary artery disease treated by percutaneous coronary interventions[J]. Catheter Cardiovasc Interv, 2015, 86(1):3-10. DOI:10. 1002/ccd. 25753.
[11] Alidoosti M,Saroukhani S,Lotfi-Tokaldany M,et al. Objectifying the level of incomplete revascularization by the residual SYNTAX score and evaluating its impact on the one-year outcome of percutaneous coronary intervention in patients with multi-vessel disease[J]. Cardiovasc Revasc Med, 2016, 17(5):308-312. DOI:10.1016/j. carrev. 2016. 03. 009.
[12]郑宏超,丁跃有,杨坚,等.心肺运动试验客观定量评估冠心病患者经皮冠状动脉介入治疗后心肺功能改变[J].中国循环杂志,2015, 30(21):156. DOI:10. 3969/j. issn. 1000-3614. 2015. z1. 425
[13] ATS, ACCP. ATS/ACCP Statement on cardiopulmonary exercise testing[J]. Am J Respir Crit Care Med, 2003, 167(2):211-277. DOI:10. 1164/rccm. 167. 2. 211.
[14] Genereux P, Palmerini T, Caixeta A, et al. Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention:the residual SYNTAX(synergy between PCI with taxus and cardiac surgery)score[J]. JACC, 2012, 59(24):2165. DOI:10.1016/j. jacc. 2012.03.010.
[2] Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden-results from the clinical outcomes utilizing revascularization and aggressive drug evaluation(COURAGE)trial nuclear substudy[J]. Circulation, 2008, 117(10):1283-1291. DOI:10. 1161/CIRCULATIONAHA. 107.743963.
[3] Hannan EL, Wu C, Walford G, et al. Incomplete revascularization in the era of drug-eluting stents:impact on adverse outcomes[J]. JACC Cardiovasc Interv, 2009, 2(1):17-25. DOI:10. 1016/j. jcin. 2008. 08.021.
[4] Kim YH, Park DW, Lee JY, et al. Impact of angiographic complete revascularization after drug-eluting stent implantation or coronary artery bypass graft surgery for multivessel coronary artery disease[J]. Circulation, 2011, 123(21):2373-2381. DOI:10. 1161/CIRCULATIONAHA. 110. 005041.
[5]高国峰,丰雷,赵延延,等.残余SYNTAX评分在中国冠心病介入患者中的应用价值研究[J].中国循环杂志,2018,33(2):117-122. DOI:10. 3969/j. issn. 1000-3614. 2018. 02. 004.
[6] De BB. Multivessel disease:from reasonably incomplete to functionally complete revascularization[J]. Circulation, 2012,125(21):2557. DOI:10. 1161/CIRCULATIONAHA. 112. 106872.
[7] Dauerman HL. Reasonable incomplete revascularization[J].Circulation, 2011, 123(21):2337-2340. DOI:10. 1161/CIRCULATIONAHA. 111.033126.
[8] Farooq V, Serruys PW, Bourantas CV, et al. Quantification of incomplete revascularization and its association with five-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery(SYNTAX)trial validation of the residual SYNTAX score[J]. Circulation, 2013, 128(2):141-151.DOI:10. 1161/CIRCULATIONAHA. 113. 001803.
[9] Xu B, Yang YJ, Han YL, et al. Validation of residual SYNTAX score with second-generation drug-eluting stents:one-year results from the prospective multicentre SEEDS study[J]. EuroIntervention, 2014,10(1):65-73. DOI:10. 4244/EIJV10I1A12.
[10] Witberg G, Lavi I, Assali A, et al. The incremental impact of residual SYNTAX score on long-term clinical outcomes in patients with multivessel coronary artery disease treated by percutaneous coronary interventions[J]. Catheter Cardiovasc Interv, 2015, 86(1):3-10. DOI:10. 1002/ccd. 25753.
[11] Alidoosti M,Saroukhani S,Lotfi-Tokaldany M,et al. Objectifying the level of incomplete revascularization by the residual SYNTAX score and evaluating its impact on the one-year outcome of percutaneous coronary intervention in patients with multi-vessel disease[J]. Cardiovasc Revasc Med, 2016, 17(5):308-312. DOI:10.1016/j. carrev. 2016. 03. 009.
[12]郑宏超,丁跃有,杨坚,等.心肺运动试验客观定量评估冠心病患者经皮冠状动脉介入治疗后心肺功能改变[J].中国循环杂志,2015, 30(21):156. DOI:10. 3969/j. issn. 1000-3614. 2015. z1. 425
[13] ATS, ACCP. ATS/ACCP Statement on cardiopulmonary exercise testing[J]. Am J Respir Crit Care Med, 2003, 167(2):211-277. DOI:10. 1164/rccm. 167. 2. 211.
[14] Genereux P, Palmerini T, Caixeta A, et al. Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention:the residual SYNTAX(synergy between PCI with taxus and cardiac surgery)score[J]. JACC, 2012, 59(24):2165. DOI:10.1016/j. jacc. 2012.03.010.