Bundhun Pravesh Kumar, Sookharee Yashna, Bholee Anita, Huang Feng
Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Tongji Hospital of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China.
Medicine (Baltimore). 2017 Jul;96(28):e7410. doi: 10.1097/MD.0000000000007410.
Should the SYNTAX score be integrated in Interventional Cardiology? Should it really be considered as a vital decision-making tool in percutaneous coronary intervention (PCI)? To confirm the importance of this score, we aimed to systematically compare the postinterventional adverse cardiovascular outcomes which were observed in patients who were allotted a low versus a high SYNTAX score.
Randomized controlled trials and observational studies which were published from January 2007 to January 2017 were identified from MEDLINE, EMBASE, and the Cochrane databases using the searched terms 'SYNTAX score and percutaneous coronary intervention.' Adverse cardiovascular outcomes were considered as the major endpoints. Risk ratios (RRs) with 95% confidence intervals (CIs) were used as the statistical parameters, and the main analysis was carried out by the RevMan 5.3 software.
Sixteen studies with a total number of 19,751 participants (8589 participants with a low versus 11,162 participants with a high SYNTAX score) were included. Current results showed mortality to be significantly higher with a higher SYNTAX score (RR 2.09, 95% CI 1.78-2.46, P = .00001). Cardiac death also significantly favored a low SYNTAX score (RR 2.08, 95% CI 1.66-2.61, P = .00001. Similarly, myocardial infarction, major adverse cardiac events, repeated revascularization, and stent thrombosis were significantly higher following a high SYNTAX score (RR 1.71, 95% CI 1.45-2.03, P = .00001; RR 2.03, 95% CI 1.81-2.26, P = .00001; RR 1.96, 95% CI 1.69-2.28, P = .00001; and RR 3.16, 95% CI 2.17-4.59, P = .00001, respectively). Even when patients with ST-segment elevation myocardial infarction were separately analyzed, a low SYNTAX score was still significantly associated with lower adverse outcomes.
This analysis is a confirmatory piece of evidence to show that the application of the SYNTAX score in Interventional Cardiology is apparently relevant. The use of this scoring system to grade patients with coronary artery disease and to further guide for revascularization should be encouraged.
SYNTAX评分是否应纳入介入心脏病学？它真的应被视为经皮冠状动脉介入治疗（PCI）中至关重要的决策工具吗？为证实该评分的重要性，我们旨在系统比较分配到低SYNTAX评分与高SYNTAX评分的患者介入治疗后的不良心血管结局。
从MEDLINE、EMBASE和Cochrane数据库中检索2007年1月至2017年1月发表的随机对照试验和观察性研究，检索词为“SYNTAX评分和经皮冠状动脉介入治疗”。不良心血管结局被视为主要终点。采用95%置信区间（CI）的风险比（RR）作为统计参数，主要分析由RevMan 5.3软件进行。
纳入16项研究，共19751名参与者（8589名低SYNTAX评分参与者与11162名高SYNTAX评分参与者）。当前结果显示，SYNTAX评分越高，死亡率显著越高（RR 2.09，95%CI 1.78 - 2.46，P = 0.00001）。心源性死亡也显著倾向于低SYNTAX评分（RR 2.08，95%CI 1.66 - 2.61，P = 0.00001）。同样，高SYNTAX评分后心肌梗死、主要不良心脏事件、再次血运重建和支架血栓形成显著更高（RR 1.71，95%CI 1.45 - 2.03，P = 0.00001；RR 2.03，95%CI 1.81 - 2.26，P = 0.00001；RR 1.96，95%CI 1.69 - 2.28，P = 0.00001；RR 3.16，95%CI 2.17 - 4.59，P = 0.00001）。即使单独分析ST段抬高型心肌梗死患者，低SYNTAX评分仍与较低的不良结局显著相关。
该分析是一项确证性证据，表明SYNTAX评分在介入心脏病学中的应用显然具有相关性。应鼓励使用该评分系统对冠状动脉疾病患者进行分级，并进一步指导血运重建。
