Suh Young Joo, Han Kyunghwa, Chang Suyon, Kim Jin Young, Im Dong Jin, Hong Yoo Jin, Lee Hye-Jeong, Hur Jin, Kim Young Jin, Choi Byoung Wook
Department of Radiology, Research Institute of Radiological Science, Severance Hospital Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Korea.
Medicine (Baltimore). 2017 Sep;96(37):e7999. doi: 10.1097/MD.0000000000007999.
The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score is an invasive coronary angiography (ICA)-based score for quantifying the complexity of coronary artery disease (CAD). Although the SYNTAX score was originally developed based on ICA, recent publications have reported that coronary computed tomography angiography (CCTA) is a feasible modality for the estimation of the SYNTAX score.The aim of our study was to investigate the prognostic value of the SYNTAX score, based on CCTA for the prediction of major adverse cardiac and cerebrovascular events (MACCEs) in patients with complex CAD.The current study was approved by the institutional review board of our institution, and informed consent was waived for this retrospective cohort study. We included 251 patients (173 men, mean age 66.0 ± 9.29 years) who had complex CAD [3-vessel disease or left main (LM) disease] on CCTA. SYNTAX score was obtained on the basis of CCTA. Follow-up clinical outcome data regarding composite MACCEs were also obtained. Cox proportional hazards models were developed to predict the risk of MACCEs based on clinical variables, treatment, and computed tomography (CT)-SYNTAX scores.During the median follow-up period of 1517 days, there were 48 MACCEs. Univariate Cox hazards models demonstrated that MACCEs were associated with advanced age, low body mass index (BMI), and dyslipidemia (P < .2). In patients with LM disease, MACCEs were associated with a higher SYNTAX score. In patients with CT-SYNTAX score ≥23, patients who underwent coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention had significantly lower hazard ratios than patients who were treated with medication alone. In multivariate Cox hazards model, advanced age, low BMI, and higher SYNTAX score showed an increased hazard ratio for MACCE, while treatment with CABG showed a lower hazard ratio (P < .2).On the basis of our results, CT-SYNTAX score can be a useful method for noninvasively predicting MACCEs in patients with complex CAD, especially in patients with LM disease.
经皮冠状动脉介入治疗与心脏手术协同作用（SYNTAX）评分是一种基于有创冠状动脉造影（ICA）的评分，用于量化冠状动脉疾病（CAD）的复杂性。虽然SYNTAX评分最初是基于ICA开发的，但最近的出版物报道，冠状动脉计算机断层扫描血管造影（CCTA）是一种用于估计SYNTAX评分的可行方法。我们研究的目的是探讨基于CCTA的SYNTAX评分对复杂CAD患者主要不良心脑血管事件（MACCE）预测的预后价值。本回顾性队列研究已获得本机构机构审查委员会的批准，且无需知情同意。我们纳入了251例患者（173例男性，平均年龄66.0±9.29岁），这些患者在CCTA上显示患有复杂CAD[三支血管病变或左主干（LM）病变]。基于CCTA获得SYNTAX评分。还获得了关于复合MACCE的随访临床结局数据。建立Cox比例风险模型，以根据临床变量、治疗和计算机断层扫描（CT）-SYNTAX评分预测MACCE的风险。在1517天的中位随访期内，发生了48例MACCE。单变量Cox风险模型表明，MACCE与高龄、低体重指数（BMI）和血脂异常相关（P<0.2）。在患有LM病变的患者中，MACCE与较高的SYNTAX评分相关。在CT-SYNTAX评分≥23的患者中，接受冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗的患者的风险比明显低于仅接受药物治疗的患者。在多变量Cox风险模型中，高龄、低BMI和较高的SYNTAX评分显示MACCE的风险比增加，而CABG治疗显示风险比降低（P<0.2）。根据我们的结果，CT-SYNTAX评分可以作为一种有用的方法，用于无创预测复杂CAD患者的MACCE，尤其是患有LM病变的患者。
