Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Am Heart J. 2011 Apr;161(4):771-81. doi: 10.1016/j.ahj.2011.01.004.
The aims of this study were to evaluate the SYNTAX score (SXscore) calculated at 2 stages during a primary percutaneous intervention (PPCI), that is, SXscore I (diagnostic) and SXscore II (postwiring), and assess its additional value to standard clinical risk scores in acute myocardial infarction.
SXscores I and II were applied to 736 consecutive acute ST-elevation myocardial infarction patients referred for PPCI between November 2006 and February 2008. SXscore changed significantly before (I: 16, interquartile range 9.5-23) and after wiring (II: 11, interquartile range 6-19), P < .001. Kaplan-Meier methods were used to compare the primary end point major adverse coronary events (MACE; composite of repeat MI, target vessel revascularization [TVR], and mortality) and secondary end point mortality at 1.5 years in tertiles of SXscore I and SXscore II. Major adverse coronary event was highest in the higher SXscore I tertile (11% vs 15% vs 23%, log-rank <0.01), driven primarily by increased rate of mortality (9% vs 11% vs 17%, log-rank 0.02). Major adverse coronary event was also highest in SXscore II tertile, by a combination of increased mortality and also TVR (TVR rate 2% vs 3% vs 9%, log-rank <0.01). Predictive Cox regression models for mortality and MACE were significantly and similarly improved by the addition of either SXscore I or SXscore II (hazard ratio 1.63, 95% CI 1.18-2.26, P < .01 for MACE) with respective c indices of 0.61 and 0.63 for MACE and 0.60 and 0.61 for mortality.
SXscore during PPCI is a useful tool that provides additional risk stratification to known risk factors of long-term mortality and MACE in patients with ST-elevation myocardial infarction.
本研究旨在评估在经皮冠状动脉介入治疗（PPCI）的两个阶段计算的 SYNTAX 评分（SXscore），即 SXscore I（诊断性）和 SXscore II（后置线），并评估其在急性心肌梗死中对标准临床风险评分的附加价值。
2006 年 11 月至 2008 年 2 月，对 736 例连续急性 ST 段抬高型心肌梗死患者进行 PPCI 治疗，应用 SXscore I 和 II。SXscore 在置线前后有显著变化（I：16，四分位距 9.5-23；II：11，四分位距 6-19），P<0.001。Kaplan-Meier 方法比较 SXscore I 和 II 三分位的主要不良冠状动脉事件（MACE；再发心肌梗死、靶血管血运重建和死亡率的复合终点）和 1.5 年死亡率的主要终点。在较高的 SXscore I 三分位，MACE 发生率最高（11%比 15%比 23%，log-rank<0.01），主要由死亡率增加驱动（9%比 11%比 17%，log-rank 0.02）。SXscore II 三分位的 MACE 发生率也最高，这是由于死亡率和靶血管血运重建率增加的共同作用（TVR 发生率 2%比 3%比 9%，log-rank<0.01）。Cox 回归模型显示，死亡率和 MACE 的预测模型均因加入 SXscore I 或 SXscore II 而显著改善（MACE 的危险比为 1.63，95%CI 为 1.18-2.26，P<0.01），相应的 C 指数分别为 0.61 和 0.63 用于 MACE，0.60 和 0.61 用于死亡率。
PPCI 期间的 SXscore 是一种有用的工具，可为 ST 段抬高型心肌梗死患者的长期死亡率和 MACE 的已知危险因素提供额外的风险分层。
