Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China.
Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
JACC Cardiovasc Interv. 2014 Oct;7(10):1128-37. doi: 10.1016/j.jcin.2014.05.018. Epub 2014 Sep 17.
This study sought to evaluate the long-term prognostic capacity of the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score II (SS-II) and compare it with other risk scores among patients undergoing left main percutaneous coronary intervention (LM-PCI).
Recently, the SS-II was developed in an attempt to individualize and help the decision-making process between PCI and coronary artery bypass graft (CABG) surgery in the management of complex coronary artery disease (CAD). However, there is a paucity of data regarding the utility of SS-II in patients undergoing LM-PCI.
Data from 1,528 consecutive patients from a single center undergoing unprotected LM-PCI were prospectively collected. The SS-II and other scores were then derived using patients' baseline clinical characteristics. Patients were stratified according to tertiles of SS-II for PCI: SS-II ≤21 (n = 508), SS-II >21 and ≤28 (n = 480), and >28 (n = 540). Predictive capability for long-term mortality was compared between angiographic scores and scores combining both angiographic and clinical variables.
At a mean follow-up of 4.4 years, mortality in the first, second, and third SS-II tertiles was 1.8%, 3.5%, and 9.4%, respectively (p < 0.0001). Multivariate analysis showed SS-II to be a strong independent predictor of mortality (hazard ratio: 1.76, 95% confidence interval: 1.10 to 2.82; p = 0.02) after LM-PCI. When compared with the angiographic SS, scores combining both clinical and angiographic variables, such as the SS-II, were superior in terms of long-term prognostication.
Results of this large series of consecutive patients who underwent unprotected LM-PCI suggested that the SS-II has better long-term prognostic power in terms of mortality compared with the original purely angiographic SS.
本研究旨在评估 SYNTAX（经皮冠状动脉介入治疗与紫杉醇和心脏手术的协同作用）评分 II（SS-II）的长期预后能力，并将其与接受左主干经皮冠状动脉介入治疗（LM-PCI）的患者中的其他风险评分进行比较。
最近，SS-II 是为了在复杂冠状动脉疾病（CAD）的管理中，针对经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）手术之间的决策过程进行个体化，并帮助决策而开发的。然而，关于 SS-II 在接受 LM-PCI 的患者中的应用价值的数据很少。
从单中心前瞻性收集了 1528 例连续接受非保护 LM-PCI 的患者的数据。然后，根据患者的基线临床特征得出 SS-II 和其他评分。根据 SS-II 的 PCI 三分位数对患者进行分层：SS-II≤21（n=508），SS-II>21 且≤28（n=480），>28（n=540）。比较了血管造影评分和结合血管造影和临床变量的评分对长期死亡率的预测能力。
在平均 4.4 年的随访中，前、中、后 SS-II 三分位数的死亡率分别为 1.8%、3.5%和 9.4%（p<0.0001）。多变量分析表明，SS-II 是 LM-PCI 后死亡率的独立强预测因素（危险比：1.76，95%置信区间：1.10 至 2.82；p=0.02）。与原始的纯血管造影 SS 相比，结合临床和血管造影变量的评分（如 SS-II）在长期预后方面更具优势。
这项接受非保护 LM-PCI 的连续患者的大型系列研究结果表明，与原始的纯血管造影 SS 相比，SS-II 在死亡率方面具有更好的长期预后能力。
