Department of Cardiac Surgery, Heart Center, University of Leipzig, Germany.
J Thorac Cardiovasc Surg. 2011 Jan;141(1):130-40. doi: 10.1016/j.jtcvs.2010.07.094.
SYNTAX study compares outcomes of coronary artery bypass grafting with percutaneous coronary intervention in patients with 3-vessel and/or left main disease. Complexity of coronary artery disease was quantified by the SYNTAX score, which combines anatomic characteristics of each significant lesion. This study aims to clarify whether SYNTAX score affects the outcome of bypass grafting as defined by major adverse cerebrovascular and cardiac events (MACCE) and its components over a 2-year follow-up period.
Of the 3075 patients enrolled in SYNTAX, 1541 underwent coronary artery bypass grafting (897 randomized controlled trial patients, and 644 registry patients). All patients undergoing bypass grafting were stratified according to their SYNTAX score into 3 tertiles: low (0-22), intermediate (22-32), and high (≥33) complexity. Clinical outcomes up to 2 years after allocation were determined for each group and further risk factor analysis was performed.
Registry patients had more complex disease than those in the randomized controlled trial (SYNTAX score: registry 37.8 ± 13.3 vs randomized 29.1 ± 11.4; P < .001). At 30 days, overall coronary bypass mortality was 0.9% (registry 0.6% vs randomized 1.2%). MACCE rate at 30 days was 4.4% (registry 3.4% vs randomized 5.2%). SYNTAX score did not significantly affect overall 2-year MACCE rate of 15.6% for low, 14.3% for medium, and 15.4% for high SYNTAX scores. Compared with randomized patients, registry patients had a lower rate of overall MACCE rate (registry 13.0% vs randomized 16.7%; P = .046) and repeat revascularization (4.7% vs 8.6%; P = .003), whereas other event rates were comparable. Risk factor analysis revealed left main disease (P = .049) and incomplete revascularization (P = .005) as predictive for adverse 2-year outcomes.
The outcome of coronary artery bypass grafting was excellent and independent from the SYNTAX score. Incomplete revascularization rather than degree of coronary complexity adversely affects late outcomes of coronary bypass.
SYNTAX 研究比较了 3 支血管病变和/或左主干病变患者行冠状动脉旁路移植术与经皮冠状动脉介入治疗的结果。通过 SYNTAX 评分量化冠状动脉疾病的复杂性，该评分综合了每个显著病变的解剖特征。本研究旨在明确 SYNTAX 评分是否会影响 2 年随访期间主要不良心脑血管事件（MACCE）及其组成部分的旁路移植术结局。
在 SYNTAX 研究的 3075 例患者中，1541 例行冠状动脉旁路移植术（897 例随机对照试验患者，644 例注册患者）。所有行旁路移植术的患者均根据 SYNTAX 评分分为 3 个三分位组：低（0-22）、中（22-32）和高（≥33）复杂性。确定每组患者在分配后 2 年内的临床结局，并进一步进行风险因素分析。
注册患者的疾病比随机对照试验患者更复杂（SYNTAX 评分：注册患者 37.8±13.3，随机对照试验患者 29.1±11.4；P＜0.001）。术后 30 天，总旁路移植死亡率为 0.9%（注册患者 0.6%，随机对照试验患者 1.2%）。术后 30 天 MACCE 发生率为 4.4%（注册患者 3.4%，随机对照试验患者 5.2%）。SYNTAX 评分并未显著影响低、中、高 SYNTAX 评分患者 2 年总体 MACCE 发生率，分别为 15.6%、14.3%和 15.4%。与随机对照试验患者相比，注册患者的总 MACCE 发生率较低（注册患者 13.0%，随机对照试验患者 16.7%；P=0.046）和再次血运重建率较低（注册患者 4.7%，随机对照试验患者 8.6%；P=0.003），而其他事件发生率相当。风险因素分析显示，左主干病变（P=0.049）和不完全血运重建（P=0.005）是 2 年不良结局的预测因素。
冠状动脉旁路移植术的结果良好，且独立于 SYNTAX 评分。不完全血运重建而非冠状动脉病变程度对冠状动脉旁路移植术后的晚期结局有不利影响。
