Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität, Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
Clin Res Cardiol. 2012 Jun;101(6):477-85. doi: 10.1007/s00392-012-0417-5.
Risk stratification is essential for the clinical decision-making process in patients undergoing revascularization of the unprotected left main coronary artery (ULMCA), since the optimal revascularization strategy still remains subject of ongoing debate.
To assess the prognostic value of angiographic versus clinical characteristics for the prediction of major adverse cardiac events (MACE) and to develop a combined risk model.
In 115 patients, who were followed up for MACE after ULMCA stenting, SYNTAX score and EuroSCORE have been calculated for a combined risk model.
Whereas the SYNTAX score was not able to predict MACE at 1 year (32.8 ± 11.7 vs. 29.1 ± 12.2, P = 0.13), the logistic EuroSCORE was significantly increased in these patients suffering a MACE at 1 year [11.9 (4.4/22.6) vs. 4.8 (2.3/14.6)%, P = 0.007]. With ROC curve validated cut-off values, the combination of EuroSCORE (>7.5%) and SYNTAX score (>25) provided incremental predictive value for risk stratification of ULMCA patients (AUC 0.71, 95% CI 0.62-0.79, P < 0.001). This combined risk model was associated with the rate of cardiac mortality (P = 0.04), non-fatal myocardial infarction (P = 0.005), and target lesion revascularization (P = 0.04) and was superior to the SYNTAX score alone (P = 0.03). High risk patients had a 7.1-fold higher risk for MACE (HR 7.1. 95% CI 2.1-24.1, P = 0.002) after 1 year.
For adequate risk assessment in ULMCA patients, consideration of both comorbidities and coronary anatomic complexity, is essential. A combination of angiographic and clinical risk scores improves the prognostic value for the prediction of 1-year MACE risk and is superior to stand-alone scores.
在接受非保护左主干冠状动脉（ULMCA）血运重建的患者中，风险分层对于临床决策过程至关重要，因为最佳血运重建策略仍存在争议。
评估血管造影与临床特征对预测主要不良心脏事件（MACE）的预后价值，并建立联合风险模型。
在 115 例 ULMCA 支架置入后随访 MACE 的患者中，计算了 SYNTAX 评分和欧洲心脏手术风险评估系统（EuroSCORE），以建立联合风险模型。
尽管 SYNTAX 评分在 1 年内不能预测 MACE（32.8 ± 11.7 比 29.1 ± 12.2，P = 0.13），但在 1 年内发生 MACE 的这些患者中，逻辑 EuroSCORE 显著升高[11.9（4.4/22.6）比 4.8（2.3/14.6）%，P = 0.007]。ROC 曲线验证的截断值显示，EuroSCORE（>7.5%）和 SYNTAX 评分（>25）的联合可提供 ULMCA 患者风险分层的增量预测价值（AUC 0.71，95%CI 0.62-0.79，P < 0.001）。该联合风险模型与心脏死亡率（P = 0.04）、非致死性心肌梗死（P = 0.005）和靶病变血运重建（P = 0.04）相关，且优于单独的 SYNTAX 评分（P = 0.03）。高危患者在 1 年后发生 MACE 的风险增加了 7.1 倍（HR 7.1，95%CI 2.1-24.1，P = 0.002）。
对于 ULMCA 患者，需要充分考虑合并症和冠状动脉解剖复杂性，以进行适当的风险评估。血管造影和临床风险评分的联合可提高预测 1 年 MACE 风险的预后价值，且优于单独的评分。
