Farooq Vasim, Serruys Patrick W
Institute of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, University of Manchester and Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom.
Erasmus University, Rotterdam, The Netherlands; International Centre for Circulatory Health, NHLI, Imperial College, London, United Kingdom.
Prog Cardiovasc Dis. 2015 Nov-Dec;58(3):316-34. doi: 10.1016/j.pcad.2015.10.002. Epub 2015 Oct 31.
The landmark Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) Trial has aided in reducing the area of uncertainty in decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with complex coronary artery disease. As part of the SYNTAX Trial, quantification of the coronary artery disease burden was prospectively undertaken by the Heart Team - consisting of at least an interventional cardiologist and cardiac surgeon - utilising the anatomical SYNTAX Score (www.syntaxscore.com) as a clinical tool in order to agree that equivalent anatomical revascularisation could be achieved. The anatomical SYNTAX Score is now advocated in both European and US revascularisation guidelines to guide decision-making between CABG and PCI as part of the SYNTAX pioneered Heart Team approach. In addition, the SYNTAX Trial has lead to the development and validation of the SYNTAX Score II, in which the anatomical SYNTAX Score was augmented with clinical variables, to allow for more objective and tailored decision making for the individual patient. Prospective validation of the SYNTAX Score II tool is currently ongoing in the SYNTAX II (ClinicalTrials.gov Identifier: NCT02015832) and EXCEL (ClinicalTrials.gov identifier: NCT01205776) trials. The present paper presents lessons learned from SYNTAX, including the development and/or validation of several SYNTAX based clinical tools, and the potential implications for current and future clinical practice.
具有里程碑意义的“紫杉醇药物洗脱支架与心脏手术协同作用（SYNTAX）试验”，有助于减少复杂冠状动脉疾病患者在经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）之间决策时的不确定性范围。作为SYNTAX试验的一部分，由至少一名介入心脏病专家和心脏外科医生组成的心脏团队前瞻性地对冠状动脉疾病负担进行了量化，利用解剖学SYNTAX评分（www.syntaxscore.com）作为临床工具，以确保能够实现等效的解剖学血运重建。目前，欧洲和美国的血运重建指南均提倡使用解剖学SYNTAX评分，作为SYNTAX首创的心脏团队方法的一部分，来指导CABG和PCI之间的决策。此外，SYNTAX试验促成了SYNTAX评分II的开发和验证，其中解剖学SYNTAX评分增加了临床变量，以便为个体患者进行更客观、更具针对性的决策。SYNTAX评分II工具的前瞻性验证目前正在SYNTAX II（ClinicalTrials.gov标识符：NCT02015832）和EXCEL（ClinicalTrials.gov标识符：NCT01205776）试验中进行。本文介绍了从SYNTAX试验中吸取的经验教训，包括几种基于SYNTAX的临床工具的开发和/或验证，以及对当前和未来临床实践的潜在影响。
