NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY, USA.
Eur Heart J. 2016 Oct 21;37(40):3103-3110. doi: 10.1093/eurheartj/ehv674. Epub 2015 Dec 18.
We sought to investigate the prognostic impact of the SYNTAX (Synergy between PCI with TAXUS and Cardiac Surgery) score (SS) on 1-year clinical outcomes in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) undergoing medical therapy only.
Among the 13 819 patients enrolled in the ACUITY trial and undergoing coronary angiogram, 4491 patients were treated with medical therapy as the initial strategy. Of those, baseline SS and complete angiographic analysis were available in 1275 patients. Patients were divided in four groups based on the presence or absence of coronary artery disease (CAD) and subsequently, among patients with CAD, by SS. Major adverse cardiac events (MACE) and its individual components (death, myocardial infarction, and unplanned revascularization) were compared between groups. Among the 1275 patients, the mean SS was 3.5 ± 7.0 (range 0-45). SYNTAX score was 0 in 842 patients, >0 and ≤5 in 170, >5 and ≤11 in 119, and >11 in 144 patients. The 1-year rates of MACE were higher in patients with CAD and higher SS. By multivariable analysis, the SS was a strong predictor of all adverse ischaemic events, including mortality. By receiver operator characteristic analysis, an SS cut-off of 8 showed the best prognostic accuracy for death and MACE.
In patients with NSTE ACS undergoing medical therapy, the SS, especially when >8, was shown to be a strong predictor of 1-year MACE, including mortality. This finding has important clinical implications for risk stratification of patients with NSTE ACS undergoing medical therapy after an initial angiogram.
我们旨在研究 SYNTAX（经皮冠状动脉介入治疗与心脏手术联合治疗与经皮冠状动脉介入治疗）评分（SS）对仅接受药物治疗的非 ST 段抬高型急性冠脉综合征（NSTE ACS）患者 1 年临床结局的预后影响。
在 ACUITY 试验中，共纳入 13819 例接受冠状动脉造影的患者，其中 4491 例患者接受药物治疗作为初始策略。其中，1275 例患者有基线 SS 和完整的血管造影分析。根据是否存在冠状动脉疾病（CAD）将患者分为 4 组，然后根据 SS 将 CAD 患者进一步分为亚组。比较各组间主要不良心脏事件（MACE）及其各组成部分（死亡、心肌梗死和计划外血运重建）的发生情况。在 1275 例患者中，平均 SS 为 3.5±7.0（范围 0-45）。842 例患者 SS 为 0，170 例患者 SS＞0 且≤5，119 例患者 SS＞5 且≤11，144 例患者 SS＞11。CAD 患者和 SS 较高的患者 1 年 MACE 发生率更高。多变量分析显示，SS 是所有不良缺血事件（包括死亡率）的强有力预测因素。通过接收者操作特征分析，SS 截断值为 8 时，对死亡和 MACE 的预测准确性最高。
在接受药物治疗的 NSTE ACS 患者中，SS，尤其是＞8 时，是 1 年 MACE（包括死亡率）的强有力预测因素。这一发现对初始血管造影后接受药物治疗的 NSTE ACS 患者的风险分层具有重要的临床意义。
