Fukui Toshihiro, Uchimuro Tomoya, Takanashi Shuichiro
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Eur J Cardiothorac Surg. 2015 Jan;47(1):66-71. doi: 10.1093/ejcts/ezu045. Epub 2014 Mar 5.
We evaluated the usefulness of the combination of European System for Cardiac Operative Risk Evaluation score (EuroSCORE II) and SYNergy between percutaneous intervention with TAXus drug-eluting stents and cardiac surgery (SYNTAX) score in predicting risks associated with early and late outcomes after coronary artery bypass grafting (CABG).
Between January 2010 and April 2012, 412 patients underwent isolated CABG at our institution. EuroSCORE II and SYNTAX score were calculated retrospectively, and their ability to predict early and long-term outcomes was evaluated. Patients were divided into four groups according to median EuroSCORE II and SYNTAX score: Group 1, low EuroSCORE II, low SYNTAX (n=103); Group 2, low EuroSCORE II, high SYNTAX (n=103); Group 3, high EuroSCORE II, low SYNTAX (n=99); and Group 4, high EuroSCORE II, high SYNTAX (n=107).
Operative death was not different among the groups; however, Group 4 had the highest major complication rate of the four groups (0 in Group 1, 2.9% in Group 2, 3.0% in Group 3 and 8.4% in Group 4; P=0.011). Multivariate analyses revealed that both high EuroSCORE II (odds ratio [OR]: 4.154; P=0.030) and high SYNTAX score (OR: 3.988; P=0.035) were independent predictors of postoperative major complications and that high EuroSCORE II was an independent predictor of late mortality (OR: 4.673; P=0.016) but high SYNTAX score was not (OR: 0.808; P=0.662). Actuarial survival rate at 3 years was the lowest in Group 4 (99.0±1.0% in Group 1, 97.7±1.6% in Group 2, 91.9±2.7% in Group 3 and 90.5±4.7% in Group 4; P=0.045).
The combination of EuroSCORE II and SYNTAX score was useful in predicting early major complications after CABG. In the long term, EuroSCORE II continued to be associated with late mortality, but SYNTAX score did not.
我们评估了欧洲心脏手术风险评估系统II(EuroSCORE II)与紫杉醇药物洗脱支架经皮介入治疗与心脏手术协同作用(SYNTAX)评分相结合在预测冠状动脉旁路移植术(CABG)后早期和晚期结局相关风险方面的效用。
2010年1月至2012年4月期间,412例患者在我们机构接受了单纯CABG手术。回顾性计算EuroSCORE II和SYNTAX评分,并评估它们预测早期和长期结局的能力。根据EuroSCORE II和SYNTAX评分中位数将患者分为四组:第1组,低EuroSCORE II,低SYNTAX(n = 103);第2组,低EuroSCORE II,高SYNTAX(n = 103);第3组,高EuroSCORE II,低SYNTAX(n = 99);第4组,高EuroSCORE II,高SYNTAX(n = 107)。
各组间手术死亡率无差异;然而,第4组是四组中主要并发症发生率最高的(第1组为0,第2组为2.9%,第3组为3.0%,第4组为8.4%;P = 0.011)。多因素分析显示,高EuroSCORE II(比值比[OR]:4.154;P = 0.030)和高SYNTAX评分(OR:3.988;P = 0.035)均为术后主要并发症的独立预测因素,高EuroSCORE II是晚期死亡率的独立预测因素(OR:4.673;P = 0.016),但高SYNTAX评分不是(OR:0.808;P = 0.662)。第4组3年精算生存率最低(第1组为99.0±1.0%,第2组为97.7±1.6%,第3组为91.9±2.7%,第4组为90.5±4.7%;P = 0.045)。
EuroSCORE II和SYNTAX评分相结合有助于预测CABG术后早期主要并发症。从长期来看,EuroSCORE II仍与晚期死亡率相关,但SYNTAX评分则不然。