Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Am Coll Cardiol. 2017 Jan 31;69(4):395-403. doi: 10.1016/j.jacc.2016.10.067.
The extent of coronary disease affects clinical outcomes and may predict the effectiveness of coronary revascularization with either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score quantifies the extent of coronary disease.
This study sought to determine whether SYNTAX scores predicted outcomes and the effectiveness of coronary revascularization compared with medical therapy in the BARI-2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial.
Baseline SYNTAX scores were retrospectively calculated for BARI-2D patients without prior revascularization (N = 1,550) by angiographic laboratory investigators masked to patient characteristics and outcomes. The primary outcome was major cardiovascular events (a composite of death, myocardial infarction, and stroke) over 5 years.
A mid/high SYNTAX score (≥23) was associated with a higher risk of major cardiovascular events (hazard ratio: 1.36, confidence interval: 1.07 to 1.75, p = 0.01). Patients in the CABG stratum had significantly higher SYNTAX scores: 36% had mid/high SYNTAX scores compared with 13% in the PCI stratum (p < 0.001). Among patients with low SYNTAX scores (≤22), major cardiovascular events did not differ significantly between revascularization and medical therapy, either in the CABG stratum (26.1% vs. 29.9%, p = 0.41) or in the PCI stratum (17.8% vs. 19.2%, p = 0.84). Among patients with mid/high SYNTAX scores, however, major cardiovascular events were lower after revascularization than with medical therapy in the CABG stratum (15.3% vs. 30.3%, p = 0.02), but not in the PCI stratum (35.6% vs. 26.5%, p = 0.12).
Among patients with diabetes and stable ischemic heart disease, higher SYNTAX scores predict higher rates of major cardiovascular events and were associated with more favorable outcomes of revascularization compared with medical therapy among patients suitable for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes; NCT00006305).
冠状动脉疾病的严重程度影响临床结局，并可能预测经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）的冠状动脉血运重建的效果。SYNTAX 评分定量评估冠状动脉疾病的严重程度。
本研究旨在确定 SYNTAX 评分是否能预测 BARI-2D 试验中与药物治疗相比，冠状动脉血运重建的结局和效果。
通过对未行血运重建的 BARI-2D 患者（N=1550）的血管造影实验室调查人员进行回顾性计算，调查人员对患者特征和结局不知情。主要结局是 5 年内主要心血管事件（死亡、心肌梗死和卒中的复合终点）。
中/高 SYNTAX 评分（≥23）与更高的主要心血管事件风险相关（风险比：1.36，95%置信区间：1.07 至 1.75，p=0.01）。CABG 组患者的 SYNTAX 评分明显较高：中/高 SYNTAX 评分的患者占 36%，而 PCI 组仅占 13%（p<0.001）。在低 SYNTAX 评分（≤22）的患者中，无论在 CABG 组（26.1%比 29.9%，p=0.41）还是 PCI 组（17.8%比 19.2%，p=0.84），血运重建与药物治疗之间的主要心血管事件均无显著差异。然而，在中/高 SYNTAX 评分的患者中，与药物治疗相比，CABG 组血运重建后的主要心血管事件发生率更低（15.3%比 30.3%，p=0.02），而 PCI 组则无差异（35.6%比 26.5%，p=0.12）。
在患有糖尿病和稳定型缺血性心脏病的患者中，较高的 SYNTAX 评分预示着更高的主要心血管事件发生率，并且与适合 CABG 的患者相比，SYNTAX 评分与经血运重建治疗的更好结局相关。（2 型糖尿病的旁路血管成形术血运重建研究；NCT00006305）。
