Melina Giovanni, Angeloni Emiliano, Refice Simone, Monti Francesco, Serdoz Roberto, Rosato Stefano, Seccareccia Fulvia, Colivicchi Furio, Serdoz Roberta, Paneni Francesco, Sinatra Riccardo
Department of Cardiac Surgery, Ospedale Sant'Andrea, Roma, Italia.
Department of Cardiac Surgery, Ospedale Sant'Andrea, Roma, Italia.
Am Heart J. 2017 Jun;188:118-126. doi: 10.1016/j.ahj.2017.03.016. Epub 2017 Mar 28.
The SYNTAX score (SS) is a determinant of outcome in patients undergoing percutaneous coronary intervention. In addition, it has been recently shown that the clinical SYNTAX score (cSS), obtained by adding clinical variables to the SS, improves the predictive power of the resulting risk model. We assessed the hypothesis that the use of the cSS may predict outcomes of patients undergoing coronary artery bypass grafting (CABG).
We measured the SYNTAX score in 874 patients undergoing isolated first time on-pump CABG. The clinical SYNTAX score was calculated at the time of the study using age, creatinine clearance and ejection fraction, the modified ACEF score, and analyses performed for major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality at 3-year follow-up.
The mean age of the study population was 70.9 ± 8.1 years, and the median cSS 14.2 (range 2.1-286.5). The ROC curve analysis showed that a cSS >14.5 (81.4% sensitivity and 67.8% specificity) was a reliable tool in discrimination of patients for the occurrence of MACCE (AUC 0.78) and all-cause mortality (AUC 0.74). Kaplan-Meier survival analysis confirmed that patients belonging to higher cSS quartiles have poorer 3-year survival (P = .0001) and MACCE-free survival (P = .0001), with respect to those with lower cSS.
This observational study has shown that the clinical SYNTAX score, incorporating the lesion-based SS and clinical-based ACEF score, predicted mid-term adverse outcomes of patients undergoing CABG and may play an important role in the risk stratification of this population. Further studies are needed to confirm these findings.
SYNTAX评分（SS）是接受经皮冠状动脉介入治疗患者预后的一个决定因素。此外，最近有研究表明，通过将临床变量添加到SS中获得的临床SYNTAX评分（cSS）可提高所得风险模型的预测能力。我们评估了使用cSS可能预测冠状动脉旁路移植术（CABG）患者预后的假设。
我们测量了874例首次接受体外循环CABG的患者的SYNTAX评分。在研究时，使用年龄、肌酐清除率和射血分数、改良的ACEF评分计算临床SYNTAX评分，并对3年随访时的主要不良心脑血管事件（MACCE）和全因死亡率进行分析。
研究人群的平均年龄为70.9±8.1岁，cSS中位数为14.2（范围2.1 - 286.5）。ROC曲线分析表明，cSS>14.5（敏感性81.4%，特异性67.8%）是区分发生MACCE（AUC 0.78）和全因死亡率（AUC 0.74）患者的可靠工具。Kaplan-Meier生存分析证实，与cSS较低的患者相比，cSS较高四分位数的患者3年生存率（P = .0001）和无MACCE生存率（P = .0001）较差。
这项观察性研究表明，结合基于病变的SS和基于临床的ACEF评分的临床SYNTAX评分可预测CABG患者的中期不良预后，并可能在该人群的风险分层中发挥重要作用。需要进一步研究来证实这些发现。
