Hara Hironori, Aoki Jiro, Tanabe Kengo, Nishi Akihiro, Tanimoto Shuzou, Nakajima Yoshifumi, Yahagi Kazuyuki, Nakashima Makoto, Hashimoto Takuya, Asami Masahiko, Watanabe Mika, Yoshida Eri, Nakajima Hiroyoshi, Hara Kazuhiro
Division of Cardiology, Mitsui Memorial Hospital, 1, Kanda-Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan.
Cardiovasc Interv Ther. 2013 Jul;28(3):258-66. doi: 10.1007/s12928-013-0165-0. Epub 2013 Feb 8.
The SYNTAX score stratifies risk among drug-eluting stent-treated patients and is based on lesion characteristics alone. The Clinical SYNTAX Score (CSS) combines the SYNTAX score with age, ejection fraction, and creatinine clearance. We assessed its ability to stratify long-term outcomes in sirolimus-eluting stents (SES)-treated patients. Between August 2004 and March 2005, 249 patients were treated with SES. Clinical follow-up was evaluated at more than 5 years. The CSS was available for 206 patients. More than 5-year clinical follow-up data (mean 2114 ± 107 days) and CSS (range 1-322, mean 35.3 ± 49.9, median 17.5) were available for 201 patients. We divided these scores into tertiles: CSS-LOW ≤ 9.5, 9.5 < CSS-MID ≤ 28, and CSS-HIGH > 28. CSS-HIGH was associated with a higher death rate (CSS-LOW 9.0 %, CSS-MID 11.9 %, CSS-HIGH 41.8 %; log-rank p < 0.001) and major adverse cardiovascular events (MACE) (CSS-LOW 29.8 %, CSS-MID 35.8 %, CSS-HIGH 61.2 %; log-rank p = 0.004). Independent predictors for death were hemodialysis [hazard ratio (HR) 3.82; p < 0.001], age (HR 1.67; p = 0.003), ejection fraction (HR 0.98, p = 0.012) and CSS (HR 1.73, p = 0.028), and those for MACE were hemodialysis (HR 2.53, p = 0.002) and CSS (HR 1.40, p = 0.028). Areas under the curve for the SYNTAX score and CSS for death were 0.60 and 0.78 (p < 0.001), whereas those for MACE were 0.58 and 0.68 (p < 0.001), respectively. The CSS predicts long-term outcomes among SES-treated patients better than the SYNTAX score.
SYNTAX评分可对接受药物洗脱支架治疗的患者的风险进行分层，且仅基于病变特征。临床SYNTAX评分（CSS）将SYNTAX评分与年龄、射血分数及肌酐清除率相结合。我们评估了其对接受西罗莫司洗脱支架（SES）治疗的患者的长期预后进行分层的能力。在2004年8月至2005年3月期间，249例患者接受了SES治疗。进行了超过5年的临床随访评估。206例患者有CSS数据。201例患者有超过5年的临床随访数据（平均2114±107天）及CSS数据（范围1 - 322，平均35.3±49.9，中位数17.5）。我们将这些评分分为三分位数：CSS - LOW≤9.5、9.5＜CSS - MID≤28以及CSS - HIGH＞28。CSS - HIGH与更高的死亡率相关（CSS - LOW为9.0%，CSS - MID为11.9%，CSS - HIGH为41.8%；对数秩检验p＜0.001）以及主要不良心血管事件（MACE）（CSS - LOW为29.8%，CSS - MID为35.8%，CSS - HIGH为61.2%；对数秩检验p = 0.004）。死亡的独立预测因素为血液透析[风险比（HR）3.82；p＜0.001]、年龄（HR 1.67；p = 0.003）、射血分数（HR 0.98，p = 0.012）及CSS（HR 1.73，p = 0.028），而MACE的独立预测因素为血液透析（HR 2.53，p = 0.002）及CSS（HR 1.40，p = 0.028）。SYNTAX评分和CSS预测死亡的曲线下面积分别为0.60和0.78（p＜0.001），而预测MACE的曲线下面积分别为0.58和0.68（p＜0.001）。CSS对接受SES治疗的患者长期预后的预测优于SYNTAX评分。
