经皮冠状动脉介入治疗后残余 SYNTAX 评分及其衍生指数对临床结局的影响：来自大型单中心的数据。
Impact of Residual SYNTAX Score and Its Derived Indexes on Clinical Outcomes after Percutaneous Coronary Intervention: Data from a Large Single Center.
机构信息
Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
出版信息
Chin Med J (Engl). 2018 Jun 20;131(12):1390-1396. doi: 10.4103/0366-6999.233958.
BACKGROUND
Residual SYNTAX score (rSS) and its derived indexes including SYNTAX revascularization index (SRI) and clinical rSS had been developed to quantify and describe the extent of incomplete revascularization. This study was conducted to explore the utility of the three scores among real-world patients after percutaneous coronary intervention (PCI).
METHODS
From January 2013 to December 2013, patients underwent PCI treatment at Fuwai Hospital were included. The primary endpoints were all-cause death and major adverse cardiovascular and cerebrovascular events. The secondary endpoints were myocardial infarction, revascularization, stroke, and stent thrombosis. Kaplan-Meier methodology was used to determine the outcomes. Cox multivariable regression was to test the associations between scores and all-cause mortality.
RESULTS
A total of 10,344 patients were finally analyzed in this study. Kaplan-Meier survival analysis indicated that greater residual coronary lesions quantified by rSS and its derived indexes were associated with increased risk of adverse cardiovascular events. However, after multivariate analysis, only clinical rSS was an independent predictor of 2-year all-cause death (hazard ratio: 1.02, 95% confidence interval: 1.01-1.03, P < 0.01). By receiver operating characteristic (ROC) curve analysis, clinical rSS had superior predictability of 2-year all-cause death than rSS and SRI (area under ROC curve [AUC]: 0.59 vs. 0.56 vs. 0.56, all P < 0.01), whereas rSS was superior in predicting repeat revascularization than clinical rSS and SRI (AUC: 0.62 vs. 0.61 vs. 0.61; all P < 0.01). When comparing the predictive capability of rSS ≥8 with SRI <70%, their predictabilities were not significantly different.
CONCLUSIONS
This study indicates that all three indexes (rSS, clinical rSS, and SRI) are able to risk-stratify patients and predict 2-year outcomes after PCI. However, their prognostic capabilities are different.
背景
残余 SYNTAX 评分（rSS）及其衍生指标，包括 SYNTAX 血运重建指数（SRI）和临床 rSS，已被开发用于量化和描述不完全血运重建的程度。本研究旨在探讨这三个评分在经皮冠状动脉介入治疗（PCI）后的真实世界患者中的应用价值。
方法
本研究纳入 2013 年 1 月至 2013 年 12 月在阜外医院接受 PCI 治疗的患者。主要终点为全因死亡和主要不良心血管和脑血管事件。次要终点为心肌梗死、血运重建、卒中和支架血栓形成。Kaplan-Meier 方法用于确定结局。Cox 多变量回归用于检验评分与全因死亡率之间的关联。
结果
本研究最终分析了 10344 例患者。Kaplan-Meier 生存分析表明，rSS 及其衍生指标所量化的残余冠状动脉病变程度越大，发生不良心血管事件的风险越高。然而，经过多变量分析，只有临床 rSS 是 2 年全因死亡的独立预测因素（危险比：1.02，95%置信区间：1.01-1.03，P<0.01）。通过接受者操作特征（ROC）曲线分析，临床 rSS 对 2 年全因死亡的预测能力优于 rSS 和 SRI（ROC 曲线下面积[AUC]：0.59 比 0.56 比 0.56，均 P<0.01），而 rSS 对重复血运重建的预测能力优于临床 rSS 和 SRI（AUC：0.62 比 0.61 比 0.61；均 P<0.01）。比较 rSS≥8 与 SRI<70%的预测能力，两者的预测能力无显著差异。
结论
本研究表明，所有三个指标（rSS、临床 rSS 和 SRI）都能够对患者进行风险分层，并预测 PCI 后 2 年的结局。然而，它们的预后能力不同。
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