Cardiovascular Department, Ferrarotto Hospital, Catania, Italy; ETNA Foundation, Catania, Italy.
Catheter Cardiovasc Interv. 2013 Sep 1;82(3):333-40. doi: 10.1002/ccd.24642. Epub 2013 Apr 8.
We investigated the prognostic accuracy of a standardized quantification of incomplete revascularization after percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (ULMCA) named residual SYNTAX score (rSS).
Prognostic implications of coronary lesions left untreated after ULMCA PCI are confounded by the lack of a uniform definition of incomplete revascularization.
Baseline SYNTAX score (bSS), rSS, and the difference between bSS and rSS (ΔSS ) were assessed in predicting the risk of 2-year cardiac mortality of 400 patients undergoing ULMCA PCI.
The rSS and bSS showed comparable discrimination (rSS area under the curve [AUC] 0.72, 95% confidence interval [95% CI] 0.61-0.83; bSS AUC 0.73, 95% CI 0.62-0.84). Hosmer-Lemeshow statistics were 0.60 for rSS (P = 0.44) and 2.45 (P = 0.12) for bSS, reflecting better calibration ability of the rSS. The ΔSS provided the worst discrimination and calibration characteristics (AUC 0.55; 95% CI 0.44-0.66; Hosmer-Lemeshow statistic 3.13, P = 0.08). The rSS was independently associated with the 2-year adjusted-risk of cardiac mortality (hazard ratio 1.07, 95% CI 1.03-1.12, P = 0.001). The risk information from both the rSS and bSS slightly improved the discrimination ability compared with risk information from each single risk assessment (AUC 0.74, 95% CI 0.62-0.86) with a net reclassification improvement of +14.2% and +13.6% over rSS and bSS alone, respectively.
The rSS carries a prognostic value as independent predictor of 2-year cardiac mortality. Compared with a single assessment of the SYNTAX score, information coming from repeat assessment of the angiographic risk may improve the ability to discriminate and reclassify patients undergoing ULMCA PCI.
我们研究了经皮冠状动脉介入治疗（PCI）无保护左主干（ULMCA）后，一种名为残余 SYNTAX 评分（rSS）的不完全血运重建标准化量化的预后准确性。
由于缺乏对不完全血运重建的统一定义，因此 ULMCA PCI 后遗留的冠状动脉病变的预后意义受到了影响。
在 400 例行 ULMCA PCI 的患者中，评估基线 SYNTAX 评分（bSS）、rSS 以及 bSS 与 rSS 之间的差值（ΔSS）预测 2 年心脏死亡率的风险。
rSS 和 bSS 的区分能力相当（rSS 曲线下面积[AUC]为 0.72，95%置信区间[95%CI]为 0.61-0.83；bSS AUC 为 0.73，95%CI 为 0.62-0.84）。Hosmer-Lemeshow 统计量 rSS 为 0.60（P = 0.44），bSS 为 2.45（P = 0.12），这表明 rSS 的校准能力更好。ΔSS 的区分能力和校准特征最差（AUC 为 0.55；95%CI 为 0.44-0.66；Hosmer-Lemeshow 统计量为 3.13，P = 0.08）。rSS 与 2 年心脏死亡率调整风险独立相关（风险比 1.07，95%CI 为 1.03-1.12，P = 0.001）。与单一风险评估相比，rSS 和 bSS 的风险信息略微提高了区分能力（AUC 为 0.74，95%CI 为 0.62-0.86），rSS 和 bSS 分别使净重新分类改善了+14.2%和+13.6%。
rSS 是 2 年心脏死亡率的独立预测因子，具有预后价值。与单一评估 SYNTAX 评分相比，重复评估血管造影风险的信息可能会提高区分和重新分类行 ULMCA PCI 患者的能力。
