Scherff Frank, Vassalli Giuseppe, Sürder Daniel, Mantovani Antonio, Corbacelli Carlo, Pasotti Elena, Klersy Catherine, Auricchio Angelo, Moccetti Tiziano, Pedrazzini Giovanni B
Department of Cardiology, CardioCentro Ticino, Via Tesserete, Lugano, Switzerland.
J Invasive Cardiol. 2011 Dec;23(12):505-10.
The SYNTAX score (SXscore), an angiographic score reflecting coronary lesion complexity, predicts clinical outcomes in patients with left main or multivessel disease, and in patients with ST-segment elevation myocardial infarction undergoing primary PCI. The clinical SXscore (CSS) integrates the SXscore and clinical variables (age, ejection fraction, serum creatinine) into a single score. We analyzed these scores in elderly patients with acute coronary syndrome (ACS) undergoing primary PCI. The purpose of this analysis was not to decide which patients should undergo PCI, but to predict clinical outcomes in this population.
The SXscore was determined in a consecutive series of 114 elderly patients (mean age, 79.6 ± 4.1 years) undergoing primary PCI for ACS. Outcomes were stratified according to SXscore tertiles: SXLOW ≤15 (n = 39), 15< SXMID <23 (n = 40), and SXHIGH ≥23 (n = 35). The primary endpoint was all-cause mortality at 30 days. Secondary endpoints were nonfatal major adverse cardiac and cerebrovascular events (MACCE) at 30 days, and 1-year outcomes in patients discharged alive.
Mortality at 30 days was higher in the SXHIGH group compared with the aggregate SXLOW+MID group (37.1% vs 5.1%; P<.0001), and in the CSSHIGH group compared with the aggregate CSSLOW+MID group (25.5% vs 1.4%; P=.0001). MACCE rates at 30 days were similar among SXscore tertiles. The CSS predicted 1-year MACCE rates (12.1% for CSSHIGH vs 3.1% for CSSLOW+MID; P=.03).
The SXscore predicts 30-day mortality in elderly patients with ACS undergoing primary PCI. In patients discharged alive, the CSS predicts risk of MACCE at 1 year.
SYNTAX评分（SXscore）是一种反映冠状动脉病变复杂性的血管造影评分，可预测左主干或多支血管病变患者以及接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死患者的临床结局。临床SYNTAX评分（CSS）将SXscore与临床变量（年龄、射血分数、血清肌酐）整合为一个单一评分。我们分析了接受直接PCI的老年急性冠状动脉综合征（ACS）患者的这些评分。本分析的目的不是决定哪些患者应接受PCI，而是预测该人群的临床结局。
在连续114例接受ACS直接PCI的老年患者（平均年龄79.6±4.1岁）中确定SXscore。结局根据SXscore三分位数分层：SXLOW≤15（n = 39），15 < SXMID < 23（n = 40），以及SXHIGH≥23（n = 35）。主要终点是30天时的全因死亡率。次要终点是30天时的非致命性主要不良心脑血管事件（MACCE）以及存活出院患者的1年结局。
与SXLOW + MID组总和相比，SXHIGH组30天时的死亡率更高（37.1%对5.1%；P <.0001），与CSSLOW + MID组总和相比，CSSHIGH组的死亡率更高（25.5%对1.4%；P =.0001）。30天时MACCE发生率在SXscore三分位数之间相似。CSS可预测1年MACCE发生率（CSSHIGH为12.1%，CSSLOW + MID为3.1%；P =.03）。
SXscore可预测接受直接PCI的老年ACS患者的30天死亡率。在存活出院的患者中，CSS可预测1年时MACCE的风险。
