Istituto di Cardiologia, Policlinico S. Orsola, Bologna, Italy.
J Am Coll Cardiol. 2011 Jun 14;57(24):2389-97. doi: 10.1016/j.jacc.2011.02.032.
We sought to investigate the predictive value of the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score (SS) for risk assessment of 1-year clinical outcomes in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention (PCI).
In the SYNTAX trial, the SS was effective in risk-stratifying patients with left main and triple-vessel coronary disease, the majority of whom had stable ischemic heart disease.
The SS was determined in 2,627 patients with non-ST-segment elevation acute coronary syndromes undergoing PCI in the angiographic substudy of the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. Patients were stratified according to tertiles of the SS: <7 (n = 854), ≥ 7 and <13 (n = 825), and ≥ 13 (n = 948).
Among patients in the first, second, and third SS tertiles, the 1-year rates of mortality were 1.5%, 1.6%, and 4.0%, respectively (p = 0.0005); the cardiac mortality rates were 0.2%, 0.9%, and 2.7%, respectively (p < 0.0001); the myocardial infarction (MI) rates were 6.3%, 8.3%, and 12.9%, respectively (p < 0.0001); and the target vessel revascularization (TVR) rates were 7.4%, 7.0%, and 9.8%, respectively (p = 0.02). By multivariable analysis, the SS was an independent predictor of 1-year death (hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.01 to 1.07; p = 0.005), cardiac death (HR: 1.06, 95% CI: 1.03 to 1.09; p = 0.0002), MI (HR: 1.03, 95% CI: 1.02 to 1.05; p < 0.0001), and TVR (HR: 1.03, 95% CI: 1.02 to 1.05; p < 0.0001). The SS affected death, cardiac death, and MI both within the first 30 days after PCI and between 30 days and 1 year, whereas it affected TVR primarily within the first 30 days. The predictive value of an increased SS was consistent among multiple pre-specified subgroups.
In patients with non-ST-segment elevation acute coronary syndromes undergoing PCI, the SS is an independent predictor of the 1-year rates of death, cardiac death, MI, and TVR. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158).
我们旨在研究 SYNTAX（经皮冠状动脉介入治疗中紫杉醇与心脏手术的协同作用）评分（SS）对非 ST 段抬高型急性冠状动脉综合征患者行经皮冠状动脉介入治疗（PCI）后 1 年临床结局风险评估的预测价值。
在 SYNTAX 试验中，SS 可有效对左主干和三血管病变患者进行风险分层，这些患者多数患有稳定型缺血性心脏病。
在 ACUITY（急性冠状动脉介入治疗和紧急干预治疗策略）试验的血管造影子研究中，对 2627 例接受 PCI 的非 ST 段抬高型急性冠状动脉综合征患者进行 SS 测定。根据 SS 的三分位数对患者进行分层：<7（n=854）、≥7 且<13（n=825）和≥13（n=948）。
在 SS 处于第一、第二和第三三分位数的患者中，1 年死亡率分别为 1.5%、1.6%和 4.0%（p=0.0005）；心源性死亡率分别为 0.2%、0.9%和 2.7%（p<0.0001）；心肌梗死（MI）发生率分别为 6.3%、8.3%和 12.9%（p<0.0001）；靶血管血运重建（TVR）发生率分别为 7.4%、7.0%和 9.8%（p=0.02）。多变量分析显示，SS 是 1 年死亡（风险比[HR]：1.04，95%置信区间[CI]：1.01 至 1.07；p=0.005）、心源性死亡（HR：1.06，95%CI：1.03 至 1.09；p=0.0002）、MI（HR：1.03，95%CI：1.02 至 1.05；p<0.0001）和 TVR（HR：1.03，95%CI：1.02 至 1.05；p<0.0001）的独立预测因素。SS 不仅影响 PCI 后 30 天内的死亡、心源性死亡和 MI，还影响 30 天至 1 年期间的上述指标，而仅在 PCI 后 30 天内影响 TVR。SS 增加的预测价值在多个预先指定的亚组中是一致的。
在接受 PCI 的非 ST 段抬高型急性冠状动脉综合征患者中，SS 是 1 年死亡率、心源性死亡率、MI 和 TVR 的独立预测因素。（急性冠脉综合征中 Angiomax 与肝素的比较；NCT00093158）。
