| Purpose:Through the comparative studyed of different coronary artery disease(hereinafter referred to as the coronary artery lesions) with the degree of coronary atherosclerosis heart disease(coronary atherosclerotic heart disease, CHD) patients with serum bilirubin(SBIL) level, the analysised of the relationship between serum bilirubin level and coronary artery disease severity(SYNTAX score and clinical SYNTAX score) and to investigated the relationship between serum bilirubin level and coronary heart disease(CHD) in patients with coronary artery disease, in the syntax score and clinical SYNTAX score respectively in CHD patients with percutaneous coronary intervention operation(percutaneous coronary intervention, PCI) after major adverse cardiac and cerebral vascular events(major adverse cardiac and cerebral vascular events,MACCE) prediction, further comparatived value of syntax score and clinical SYNTAX score for predicting the prognosis.method:Retrospective analysised of January January 2013 to 2014 in Jiangxi Province People’s hospital heart internal Coyne chest tightness, chest pain and confirmed by angiography for CHD and accept 191 patients with PCI to collected general information on all patients, included name, gender, age, past history(hypertension, hyperlipidemia, diabetes, previous myocardial infarction and other cardiac disease history), smoked history, family history of coronary heart disease, and left with the morning fasted blood, by immune dialysised than turbidimetric method determination of biochemical indicators, included total bilirubin(total bilirubin, TBIL), direct bravery red pigment(DIR The calculation results of ECT bilirubin, DBIL) and indirect bilirubin(indirect bilirubin, IBILl), low density lipoprotein cholesterol(low density lipoprotein cholesterol, LDL-C) and uric acid(UA), creatinine(CREA). According to the preoperatived coronary angiography(coronary angiography,CAG) obtained SYNTAX score, according to the calculationed of SYNATX integration,combined with the patient’s age, left ventricular ejection fraction(left ventricular ejection fraction, LVEF) and crea calculationed the clinical SYNTAX score. By two kinds of integral numerical respectively CHD patients were divided into two groups: low risk group, middle risk group and high risk group. Through the analysised of the level of serum bilirubin with syntax score and clinical syntax scores acquired correlation to the relationship between bilirubin levels and severity of coronary artery lesion. Through telephone or clinic follow-up recorded the MACCE events of CHD patients after PCI, all were followed up for 24 months. Analysised syntax score and clinical SYNTAX score of MACCE event prediction, compared SYNTAX score and clinical SYNTAX score of value to the prediction of the prognosis of patients with CHD after PCI, all data were applied WPS2016 excel table and SPSS17.0 software carries on statistics processing, all the analysis were to P<0.05 difference has statistical significance.Results:1. This study included 191 cases of CHD patients, were followed up for 24 months and lost to follow-up in 19 cases, and the follow-up rate was 90.05%. Among them, general information: the 141 cases of male(81.98%) and 31 female(18.02%) accounted for, and the youngest is 34 years old, aged 85 years old, with an average age of 63.47 + 977 year old. Left ventricular ejection fraction(54.73 + 8.43)%; History: had previous history of myocardial infarction in 12 cases(6.98%), history of hypertension in 86 cases(50%), history of diabetes mellitus(DM) 32 cases(18.60 %) and hyperlipidemia history of 28 cases(16.28%), smoking history of 102 cases(59.30%), 4 cases had a family history of coronary heart disease(2.32%); clinical diagnosis: stable angina pectoris in 10 cases(5.81%), 86 cases of unstable angina pectoris(50%), 76 cases with acute myocardial infarction(44.17%); characteristics of coronary artery: single branch lesions in 25 cases(14.53%), 24 patients with double vessel lesion(13.95%), 65 cases of triple vessel disease(accounting for 37.79%); other features: average stent implantation for a few pieces of 1.73 + 0.98, complete revascularization 134 cases(accounted for 77.9%), serum creatinine(>176.8mmol/L) in 2 cases(1.16%), left ventricular ejection fraction in 14 cases(8.14%), age(over 80 years) and 4 cases(2.33%). Integral: syntax score 1-61, average of 21.54 + 12.46 points; clinical SYNTAX score 1.22-128.32, average 23.23(12.18,36.96), ACEF score, average 1.21 + 0.33.2.SYNTAX integral low risk group, medium risk group and high risk group of age has significant difference(P<0.05), syntax integral in the high-risk group of age was significantly higher than that of the low-risk group, among the three groups of gender, hypertension, diabetes, hyperlipidemia, smoking and coronary heart disease(CHD) family there was no significant difference(P>0.05). Among the three groups and biochemical indexes of TBIL, DBIL and ibil exist significant difference(P <0.05), the syntax score high risk group of TBIL, DBIL and ibil below the other two groups, the syntax score in the risk group of TBIL, IBI L was lower than the low risk group. There was no statistical difference(P>0.05) between the middle group and low risk group. There was no significant difference in LDL-C, CREA and UA between the three groups(P>0.05).3. Clinical SYNTAX score in the low risk group, the age of risk group and high risk group, hyperlipidemia, and left ventricular ejection fraction(LVEF) exist significant difference(P<0.05) and clinical syntax integral in the high-risk group of age than the other two groups, the clinical syntax integral high-risk group of LVEF was lower than that of the other two groups, clinical syntax integral low risk group of hyperlipidemia than high-risk group. Among the three groups of TBIL, DBIL and ibil exist significant difference(P<0.05), pairwise comparison showed that the clinical syntax integral in the high-risk group of TBIL, DBIL and ibil were significantly lower than those of the other Two groups, clinical syntax product in the risk group of TBIL and ibil were significantly lower than the low risk group, medium risk group and low-risk group of DBIL no statistical difference(P > 0.05). Among the three groups of UA and LDL-C were no statistical significance(P > 0.05) and crea differences among the three groups have statistical significance(P < 0.05), clinical syntax integral in the high-risk group of crea was significantly higher than that of the other two groups.4.There was a significant negative correlation between 4.TBIL and age, the correlation coefficient was r=-0.202, TBIL and EF, LDL-C, CREA, UA, sex, hypertension, diabetes mellitus, hyperlipidemia, smoking was not statistically significant(P>0.05).5.The correlation of 5.Spearman correlation coefficients of serum bilirubin levels and syntax scores and clinical SYNTAX score. The results showed that TBIL, DBIL and ibil at 0.01 level and the syntax score exists significant negative to the relevant, the correlation coefficient respectively-0.630, 0.437 and-0.645, namely TBIL, DBIL and ibil value is higher, the syntax score lower.TBIL, DBIL and ibil at 0.01 level and clinical SYNTAX score level exist significant negative related to the correlation coefficient Respectively-0.509,-0.311 and-0.544, namely TBIL, DBIL and IBIL value is higher, the clinical SYNTAX score is lower.6. The ordinal logistic regression analysis showed that TBIL of syntax score and clinical SYNTAX score have independent effects, TBIL higher and higher, the syntax score and clinical SYNTAX score lower, as an independent factor influence factor influence the severity of coronary artery disease. It is not considered DBIL and ibil of syntax score and clinical SYNTAX score have independent effects.7 patients were followed up for 24 months, 18 cases of CHD were found to have MACCE events, including 3 cases of cerebral apoplexy, 5 cases of PCI treatment, 2 cases of CABG, 8 cases of death due to death, the total incidence rate of 10.47%. was MACCE8.SYNTAX integral low risk group, in risk group and high risk group of MACCE rate were 3.13%, 11.36%, 31.25% and MACCE SYNTAX score high risk group and risk group rate, low risk between group differences were statistically significant(P = 0.001, P = 0.032), the difference in risk group and the low score group in the syntax score no statistical significance(P = 0.119). Clinical SYNTAX score in the low risk group, medium risk group and high risk group of MACCE occurred rate was 1.72% respectively, 8.77%, 21.05% and MACCE Incidence rate of clinical SYNTAX score in the high-risk group and low-risk group difference was statistically significant(P = 0.003), high-risk groups and risk group difference no statistical significance(P = 0.66), the difference in risk group and the low score group no statistical significance(P = 0.201).9.SYNTAX and clinical SYNTAX score low risk group, intermediate risk group and the high risk group log rank test comparing different groups of survival, the syntax score x2=22.807, log-rank P<0.001 and illustrate different syntax scores between the survival were statistically significant and clinical SYNTAX score x2=16.402, log-rank P<0.001, indicating different clinical syntax scores between the survival were statistically significant.10. Univariate Cox regression analysis of the syntax score, clinical SYNTAX score, age, hypertension, diabetes, hyperlipidemia, TBIL of MACCE prediction function, single factor analysis results show SYNTAX score is of MACCE independent predictors of the risk(HR 2.805,95.0% CI:1. 722 to 4.569, P = 0.000). Clinical synta integral is of MACCE independent predictors of the risk(HR 3.061,95.0% CI:1. 650 ~ 5.676, P(= 0), TBIL is the risk factor for MACCE(0.904,95.0% CI:0. HR: 822 ~ 0.995, P = 0.040), and age, hypertension, diabetes mellitus, hyperlipidemia are not independent risk predictors of MACCE.11. Receiver operating characteristic(receiver operator characteristic curve, ROC)curve analysis showed that incident in MACCE SYNTAX score to predict the optimal critical value 22.50, sensitivity and specificity were 80.00% and 61.90%. Clinical SYNTAX score prediction of cardiovascular and cerebrovascular events in the optimal critical value is 50.155, sensitivity and specificity were 48.00% and 94.56%.SYNTAX integral ROC curve area are Aunder the curve(AUC) of 0.756 and clinical SYNTAX score under the ROC curve area of 0.764, can think SYNTAX score and clinical SYNTAX score can predict MACCE event, the difference in area under the ROC curve of the syntax score and clinical SYNTAX score no significant 0.756vs0.764 P=0.916, joined the age, crea, LVEF Clinical SYNTAX score of fraction failed to improve the predictive ability of MACCE events in patients with CHD after PCI.Conclusion:1.The level of serum bilirubin was negatively correlated with the SYNTAX score and clinical SYNTAX score, indicating that the low serum bilirubin level in patients with CHD was negatively correlated with the degree of coronary artery disease.2.Low level of serum bilirubin was affect CHD patients with coronary artery SYNTAX score, independent risk factors for clinical SYNTAX score, suggesting that low serum bilirubin play a certain synergistic effect in the development of in the pathogenesis of coronary atherosclerosis.3.there was a significant negative correlation between TBIL and age in all groups(low, middle and high risk groups), with LVEF, LDL-C, CREA, UA, sex, hypertension, diabetes mellitus, hyperlipidemia, smoked and no significant correlation.4.SYNTAX score and clinical SYNTAX score were independent predictors of MACCE events after percutaneous coronary revascularization in patients with CHD and role of PCI postoperative MACCE events were ideal prediction. The present study joined the age, LVEF and CERA three important clinical information in clinical SYNTAX score for prediction of MACCE event is not better than simple syntax score after percutaneous coronary revascularization in patients with CHD.5.TBIL was an independent predictor of MACCE events after PCI in patients with CHD. |
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