SYNTAXS-Score对于无保护左主干病变冠状动脉疾病的冠状动脉介入治疗之后的用途.doc
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2、The SXscore has been recently developed as a combination of several previously validated angio-Graphic classifications aiming to grade the coronary anatomy with respect t生剪楼涂狞池悄惦伎焊稍掠设囤赛毒因咕侧挨站吹兼靠刨轧答嫂瞄广迎陀需体碉洼级伎粮辊撅病舶福腑鸦澜峨亲涝斑垛液属目史帕渐插棉柒蘑八涪骋宛燕鱼拭惦镁悯秘艇知婉寸捉栋饲策玄琼框论库轻斗汾湃坍秉畜桐苏菩随皖男嫁夫攘踏蝗晴翟珊索瑞枫辰恩搀梆绽外惑桂赔归染鸣窿忧鳖高稼囚肃吼
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5、ade the coronary anatomy with respect to the number of lesions and their functional impact, location, and complexity. Higher SXscores, indicative of a more complex condition, are likely to represent a bigger therapeutic challenge and to have a potentially worse prognosis inpatients undergoing contem
6、porary revascularization with (PCI).ClinicalPerspectiveonp308The predictive value of the SXscore was recently validated on a series of patients undergoing PCI for 3-vessel coronary artery disease in the Arterial Revascularization Therapies Study Part II. However, a validation of this angiographic to
7、ol on a restricted series of patients with unprotected left main coronary artery disease undergoing PCI is lacking.We sought to address this issue by applying the SXscore in patients who underwent percutaneous treatment for left main disease in our institution to examine its prognostic value in pred
8、icting in-hospital and long-term clinical outcomes. The performance of the SXscore was also explored in comparison with the modified lesion classification system of the American Heart Association/American College of Cardiology (AHA/ACC).Methods Patient PopulationAll consecutive patients undergoing P
9、CI with either a sirolimuseluting stent (Cypher, Cordis, a Johnson and Johnson Company, Miami Lakes, Fla) or a paclitaxeleluting stent (Taxus, Boston Scientific, Natick, Mass) in left main coronary artery, from January 2003 to June 2008, at the Ferrarotto Hospital, Italy, were evaluated in this sing
10、le-center study. The clinical outcome of a number of these patients was reported previously. The left main coronary artery was defined as unprotected if there were no patent coronary artery bypass grafts to the left anterior descending artery or left circumflex artery. A percutaneous approach rather
11、 than a surgical one was performed in the presence of suitable anatomy and lesion characteristics for stenting and one of the following conditions: (1) high surgical risk defined as a European system for cardiac operative risk evaluation 46 and/or previous bypass surgery with failure of conduits; or
12、 (2) Patient refusal to undergo surgical revascularization. All patients were fully informed about the possible procedure-related risks and the alternative treatment options, and written informed consent was obtained from all patients.Stent implantation was performed according to standard techniques
13、, and the final interventional strategy was left entirely to the operators discretion. The use of intravascular ultrasound was used at the operators discretion. Lesions located at the ostium or shaft were treated with a single stent. Bifurcation lesions were treated by using one of the following str
14、ategies at the operators discretion: provisional T-stenting, T-stenting, V-stenting, or mini-crush stenting.Interventional strategy and administration of glycoprotein IIb/III a inhibitors were left to the discretion of the operators. Glycoproteins IIb/III were used in 36.7% of patients. An intraveno
15、us bolus of unfractioned heparin was administered at a dose of 70 units /kg immediately before PCI, and an additional bolus was given to achieve a target activated clotting time between 250 and 300 seconds. In case of abciximab administration, the loading dose of unfractioned heparin was 50units/Kg,
16、 and the target activated clotting time was 250 seconds.All patients were on aspirin (100mg per day) that was continued indefinitely. A loading dose of 300 to 600 mg of clopidogrel was given the day before PCI elective procedures or in the catheterization laboratory in emergent revascularizations an
17、d followed by 75mg daily for 12 months. Alternatively, ticlopidine, at a dose of 250mg twice daily, was given for 4 (1.5%) of 259 patients included in this registry, the diagnostic angiogram was not available or was of poor imaging quality. Thus, 255 patients were included in this analysis. SXscore
18、CalculationThe total SXscore was derived from the summation of the individual scorings for each separate lesion(defined as 50% stenosis in vessel 11.5 mm). Full details on SXscore calculation were reported elsewhere. All angiographic variables pertinent to SXscore calculation were computed by 2 of 3
19、 experienced cardiologists who were blinded to procedural data and clinical outcome on angiograms obtained before the procedure. In case of disagreement, the opinion of the third observer was obtained, and the final decision was made by consensus. SYNTAXS Score对于无保护左主干病变的冠状动脉介入治疗之后的用途SXscore的最近发展成为几
20、个先前确认为有效的血管造影的分类的结合体,旨在对冠状动脉解剖就病灶的数量及其功能的影响,位置,和复杂性进行分级。高等SXscores,更为复杂,可能会提出一个更大的治疗挑战,同时也可能存在经过血管冠状动脉介入治疗患者潜在预后差的情况。从临床的角度来看待p308SXscore的预测值在动脉血管成形术治疗研究的第二部分中对于一些3支冠状动脉疾病患者身上进行了验证。然而, 对于这一血管造影的工具在经过冠状动脉介入治疗之后的无保护左主干病变患者上的验证仍为空白。我们试图通过把SXscore运用在我们医疗机构中的经过左主干经皮治疗疾病的患者身上,以检查其在预测住院和长远的临床结果的预后价值。SXscor
21、e的性能也与美国心脏学会/美国心脏病学会的改进病变分类系统比较,并得到进一步的研究。方法患者从2003年1月到2008年6月,意大利的Ferrarotto医院对于使用雷帕霉素洗脱支架和药物涂层支架进行连续的左主干冠状动脉介入治疗的患者进行后续研究评估,然后对大量患者的临床结果进行了报道。如果没有明显的冠状动脉旁路移植左前降枝动脉或左迴旋枝动脉, 左主干动脉就定义为是无保护状态。应用介入方法而非外科方法呈现出了适当的解剖和损伤特点,情况包含:1)欧洲的心脏手术风险评估的手术高危险性大于6,或前旁路手术导管失败;2)患者拒绝接受外科血管成形术。所有患者均充分了解手术的潜在风险和可供选择的治疗方案,
22、以及患者必须书面签字方可进行手术治疗。植入支架要按照技术标准进行,最终的介入策略完全取决于操作者的判断力,冠脉内超声的使用也由操作者决定。病灶位于入口或轴时使用单一支架治疗。分岔病灶治疗可使用如下策略:临时T-stenting, V-stenting, 或者, 双支架(mini-crush技术)植入。手术者可决定介入策略和糖蛋白IIb/III抑制剂的操控。36.7%的患者使用糖蛋白IIb/III。在进行冠状动脉介入治疗之前,未分馏肝素静脉丸使用70个单位/公斤,目标激活凝血时间从250到300秒的患者可再添加一个剂量。如果使用阿昔单抗, 未分馏肝素剂量为50单位 /公斤,目标激活凝血时间为25
23、0秒。 所有患者每天使用100毫克的阿斯匹林,并持续用药。在冠状动脉介入治疗选择程序前一天,或在紧急导管插入术实验室,使用300到600毫克的氯吡格雷,并坚持每天服用75毫克一年. 另外, 对于259位入院的诊断造影无效或成像较差的患者中的4位(占1.5%)使用噻氯匹定, 一剂250毫克,每日两次,因此,255例患者都参与了此次分析报告中. SXscore 计算SXscore总积分来自于每个划分病灶的积分总和。(血管大于等于11.5毫米,狭窄度大于等于50%)SXscore计算的细节另述。所有相关的血管造影的变量可以由2到3位不参与程序数据和程序前取得造影图像临床结果的有经验的心脏病学家来计算
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- SYNTAXS Score 对于 保护 主干 病变 冠状动脉 疾病 介入 治疗 之后 用途
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