经皮冠状动脉介入治疗后未经治疗的冠状动脉疾病的量化和影响：残余 SYNTAX（紫杉醇与心脏手术联合 PCI 的协同作用）评分。
Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) score.
机构信息
Columbia University Medical Center and the Cardiovascular Research Foundation, 111 East 59th Street, New York, NY 10022, USA.
出版信息
J Am Coll Cardiol. 2012 Jun 12;59(24):2165-74. doi: 10.1016/j.jacc.2012.03.010. Epub 2012 Apr 4.
OBJECTIVES
The purpose of this study was to quantify the extent and complexity of residual coronary stenoses following percutaneous coronary intervention (PCI) and to evaluate its impact on adverse ischemic outcomes.
BACKGROUND
Incomplete revascularization (IR) after PCI is common, and most studies have suggested that IR is associated with a worse prognosis compared with complete revascularization (CR). However, formal quantification of the extent and complexity of residual atherosclerosis after PCI has not been performed.
METHODS
The baseline Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score (bSS) from 2,686 angiograms from patients with moderate- and high-risk acute coronary syndrome (ACS) undergoing PCI enrolled in the prospective ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial was determined. The SS after PCI was also assessed, generating the "residual" SS (rSS). Patients with rSS >0 were defined as having IR and were stratified by rSS tertiles, and their outcomes were compared to the CR group.
RESULTS
The bSS was 12.8 ± 6.7, and after PCI the rSS was 5.6 ± 2.2. Following PCI, 1,084 patients (40.4%) had rSS = 0 (CR), 523 (19.5%) had rSS >0 but ≤2, 578 (21.5%) had rSS >2 but ≤8, and 501 patients (18.7%) had rSS >8. Age, insulin-treated diabetes, hypertension, smoking, elevated biomarkers or ST-segment deviation, and lower ejection fraction were more frequent in patients with IR compared with CR. The 30-day and 1-year rates of ischemic events were significantly higher in the IR group compared with the CR group, especially those with high rSS. By multivariable analysis, rSS was a strong independent predictor of all ischemic outcomes at 1 year, including all-cause mortality (hazard ratio: 1.05, 95% confidence interval: 1.02 to 1.09, p = 0.006).
CONCLUSIONS
The rSS is useful to quantify and risk-stratify the degree and complexity of residual stenosis after PCI. Specifically, rSS >8.0 after PCI in patients with moderate- and high-risk ACS is associated with a poor 30-day and 1-year prognosis. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes; NCT00093158).
目的
本研究旨在定量评估经皮冠状动脉介入治疗（PCI）后残余冠状动脉狭窄的程度和复杂性，并评估其对不良缺血结局的影响。
背景
PCI 后存在不完全血运重建（IR）较为常见，大多数研究表明 IR 与完全血运重建（CR）相比预后更差。然而，尚未对 PCI 后残余动脉粥样硬化的程度和复杂性进行正式量化。
方法
从接受 PCI 的中高危急性冠状动脉综合征（ACS）患者的 2686 张血管造影图像中确定基线 Synergy Between PCI With Taxus and Cardiac Surgery（SYNTAX）评分（bSS），并评估 PCI 后的 SS，生成“残余”SS（rSS）。rSS＞0 定义为存在 IR，并按 rSS 三分位分层，将其与 CR 组进行比较。
结果
bSS 为 12.8±6.7，PCI 后 rSS 为 5.6±2.2。PCI 后 1084 例（40.4%）患者 rSS=0（CR），523 例（19.5%）rSS＞0 但≤2，578 例（21.5%）rSS＞2 但≤8，501 例（18.7%）rSS＞8。与 CR 组相比，IR 组患者年龄更大、接受胰岛素治疗的糖尿病、高血压、吸烟、标志物升高或 ST 段偏移以及射血分数更低。IR 组患者 30 天和 1 年缺血事件发生率明显高于 CR 组，尤其是 rSS 较高的患者。多变量分析显示，rSS 是 1 年所有缺血结局的独立预测因素，包括全因死亡率（风险比：1.05，95%置信区间：1.02 至 1.09，p=0.006）。
结论
rSS 可用于定量评估 PCI 后残余狭窄的程度和复杂性，并对其进行风险分层。具体来说，中高危 ACS 患者 PCI 后 rSS＞8.0 与 30 天和 1 年不良预后相关。（急性冠状动脉综合征中 Angiomax 与肝素的比较；NCT00093158）。
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