Chung Wen-Jung, Chen Chung-Yu, Lee Fan-Yen, Wu Chia-Chen, Hsueh Shu-Kai, Lin Cheng-Jei, Hang Chi-Ling, Wu Chiung-Jen, Cheng Cheng-I
From the Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital (W-JC, S-KH, C-JL, C-LH, C-JW, C-IC); Chang Gung University College of Medicine (W-JC, F-YL, C-CW, S-KH, C-JL, C-LH, C-JW, C-IC); Department of Pharmacy, Kaohsiung Medical University Hospital, School of Pharmacy, Master Program in Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung (C-YC); and Department of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C. (F-YL, C-CW).
Medicine (Baltimore). 2015 Jun;94(23):e927. doi: 10.1097/MD.0000000000000927.
Several risk stratification scores, based on angiographic or clinical parameters, have been developed to evaluate outcomes in patients with left main coronary artery disease (LMCAD) who undergo coronary artery bypass grafting (CABG). This study aims to validate the predictive ability of different risk scoring systems with regard to long-term outcomes after CABG. This single-center study retrospectively re-evaluated the Synergy Between PCI with TAXUS and Cardiac Surgery (SYNTAX) score; EuroSCORE; age, creatinine, and ejection fraction (ACEF) score; modified ACEF score; clinical SYNTAX; logistic clinical SYNTAX score (logistic CSS); and Parsonnet scores for 305 patients with LMCAD who underwent CABG. The endpoints were 5-year rate of all-cause death and major adverse cardio-cerebral events (MACCEs), including cardiovascular (CV) death, myocardial infarction (MI), and stroke and target vessel revascularization (TVR). Compared with the SYNTAX score, other scores were significantly higher in discriminative ability for all-cause death (SYNTAX vs others: P < 0.01). The EuroSCORE ≥6 showed significant outcome difference on all-cause death, CV death, MI, and MACCE (P < .01). Multivariate analysis indicated the SYNTAX score was a non-significant predictor for different outcomes. Adjusted multivariate analysis revealed that the EuroSCORE was the strongest predictor of all-cause death (hazard ratio[HR]: 1.17; P < 0.001), CV death (HR: 1.16; P < 0.001), and MACCE (HR: 1.09; P = 0.01). The ACEF score and logistic CSS were predictive factors for TVR (HR: 0.25, P = 0.03; HR: 0.85, P = 0.01). The EuroSCORE scoring system most accurately predicts all-cause death, CV death, and MACCE over 5 years, whereas low ACEF score and logistic CSS are independently associated with TVR over the 5-year period following CABG in patients with LMCAD undergoing CABG.
基于血管造影或临床参数，已经开发了几种风险分层评分系统，用于评估接受冠状动脉旁路移植术（CABG）的左主干冠状动脉疾病（LMCAD）患者的预后。本研究旨在验证不同风险评分系统对CABG术后长期预后的预测能力。这项单中心研究对305例接受CABG的LMCAD患者的紫杉醇药物洗脱支架与心脏外科手术协同研究（SYNTAX）评分、欧洲心脏手术风险评估系统（EuroSCORE）、年龄、肌酐和射血分数（ACEF）评分、改良ACEF评分、临床SYNTAX评分、逻辑临床SYNTAX评分（logistic CSS）以及Parsonnet评分进行了回顾性重新评估。终点指标为全因死亡和主要不良心脑血管事件（MACCE）的5年发生率，包括心血管（CV）死亡、心肌梗死（MI）、中风以及靶血管血运重建（TVR）。与SYNTAX评分相比，其他评分在全因死亡的鉴别能力上显著更高（SYNTAX评分与其他评分比较：P<0.01）。EuroSCORE≥6在全因死亡、CV死亡、MI和MACCE方面显示出显著的预后差异（P<0.01）。多变量分析表明，SYNTAX评分对不同预后并非显著的预测指标。校正后的多变量分析显示，EuroSCORE是全因死亡（风险比[HR]：1.17；P<0.001）、CV死亡（HR：1.16；P<0.001）和MACCE（HR：1.09；P=0.01）的最强预测指标。ACEF评分和logistic CSS是TVR的预测因素（HR：0.25，P=0.03；HR：0.85，P=0.01）。EuroSCORE评分系统最准确地预测了5年内的全因死亡、CV死亡和MACCE，而低ACEF评分和logistic CSS与接受CABG的LMCAD患者CABG术后5年内的TVR独立相关。
