Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California 94305, USA.
J Am Coll Cardiol. 2011 Sep 13;58(12):1211-8. doi: 10.1016/j.jacc.2011.06.020.
This study was aimed at investigating whether a fractional flow reserve (FFR)-guided SYNTAX score (SS), termed "functional SYNTAX score" (FSS), would predict clinical outcome better than the classic SS in patients with multivessel coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).
The SS is a purely anatomic score based on the coronary angiogram and predicts outcome after PCI in patients with multivessel CAD. FFR-guided PCI improves outcomes by adding functional information to the anatomic information obtained from the angiogram.
The SS was prospectively collected in 497 patients enrolled in the FAME (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) study. FSS was determined by only counting ischemia-producing lesions (FFR ≤ 0.80). The ability of each score to predict major adverse cardiac events (MACE) at 1 year was compared.
The 497 patients were divided into tertiles of risk based on the SS. After determining the FSS for each patient, 32% moved to a lower-risk group as follows. MACE occurred in 9.0%, 11.3%, and 26.7% of patients in the low-, medium-, and high-FSS groups, respectively (p < 0.001). Only FSS and procedure time were independent predictors of 1-year MACE. FSS demonstrated a better predictive accuracy for MACE compared with SS (Harrell's C of FSS, 0.677 vs. SS, 0.630, p = 0.02; integrated discrimination improvement of 1.94%, p < 0.001).
Recalculating SS by only incorporating ischemia-producing lesions as determined by FFR decreases the number of higher-risk patients and better discriminates risk for adverse events in patients with multivessel CAD undergoing PCI.
本研究旨在探讨在接受经皮冠状动脉介入治疗（PCI）的多支血管病变冠心病（CAD）患者中，基于血流储备分数（FFR）的 SYNTAX 评分（SS），即“功能 SYNTAX 评分”（FSS），是否比经典 SS 更能预测临床结局。
SS 是一种基于冠状动脉造影的纯解剖评分，可预测多支 CAD 患者 PCI 后的结局。FFR 指导下的 PCI 通过在造影获得的解剖信息中加入功能信息，改善了预后。
前瞻性收集了 497 例 FAME（血流储备分数与多支血管评估的血管造影比较）研究中的患者的 SS。FSS 仅通过计算引起缺血的病变（FFR ≤ 0.80）来确定。比较了两种评分预测 1 年主要不良心脏事件（MACE）的能力。
497 例患者根据 SS 分为风险三分位数。确定每位患者的 FSS 后，32%的患者转移到低危组，具体情况如下。低、中、高 FSS 组患者的 MACE 发生率分别为 9.0%、11.3%和 26.7%（p < 0.001）。只有 FSS 和手术时间是 1 年 MACE 的独立预测因素。与 SS 相比，FSS 对 MACE 的预测准确性更高（FSS 的 Harrell C 为 0.677，SS 为 0.630，p = 0.02；综合判别改善 1.94%，p < 0.001）。
仅通过 FFR 确定引起缺血的病变重新计算 SS，可减少高危患者的数量，并更好地区分接受 PCI 的多支 CAD 患者不良事件的风险。
