Brener Sorin J, Alapati Venkatesh, Chan Doris, Da-Wariboko Akanibo, Kaid Yousef, Latyshev Yevgeniy, Moussa Amr, Narayanan Chockalingham A, O'Laughlin John P, Raizada Amol, Verma Gautam, Sacchi Terrence J
NY Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215 USA.
J Invasive Cardiol. 2018 Aug;30(8):290-294. Epub 2018 Jun 15.
Short-term outcome after percutaneous coronary intervention (PCI) has improved dramatically, but the association between clinical or angiographic characteristics and long-term outcome remains less well described. The SYNTAX (Synergy Between PCI With TAXUS and Cardiac Surgery) II score has been designed to overcome the limitations of the purely angiographic SYNTAX I score by including clinical parameters and comorbidities. It has not been tested extensively in "real-world" PCI patients, outside of randomized clinical studies.
We identified unique patients undergoing PCI between January 1, 2011 and January 24, 2013 and followed for at least 60 days. We calculated the SYNTAX I and II scores for each patient and collected data at longest follow-up available for vital status, recurrent PCI, systolic heart failure, stroke, or Q-wave myocardial infarction. Cox proportional hazards regression was used to assess independent predictors of mortality. There were 831 patients followed for a mean of 4 years. The average age was 66 ± 10 years. Nearly 40% were women and 50% had diabetes mellitus. The mean follow-up interval was 4 years, during which 42 patients died (Kaplan-Meier rate, 4.3% [IQR, 3.0-6.2%]). The PCI-SYNTAX II score was significantly higher in patients who died than in survivors (43 ± 12 vs 32 ± 12, respectively; P<.001). The SYNTAX II score was the only variable associated with death at a mean follow-up of 4 years (hazard ratio per 1 point, 1.05 [95% confidence interval, 1.03-1.08]; P<.001).
The SYNTAX II score, incorporating angiographic and clinical parameters, is a useful tool for risk stratification and prediction of 4-year mortality in "real-world" patients.
经皮冠状动脉介入治疗（PCI）后的短期疗效有了显著改善，但临床或血管造影特征与长期疗效之间的关联仍描述得不够充分。SYNTAX（紫杉醇洗脱支架PCI与心脏外科手术的协同作用）II评分旨在通过纳入临床参数和合并症来克服单纯血管造影SYNTAX I评分的局限性。除了随机临床研究外，它尚未在“真实世界”的PCI患者中进行广泛测试。
我们确定了2011年1月1日至2013年1月24日期间接受PCI且随访至少60天的独特患者。我们计算了每位患者的SYNTAX I和II评分，并在可获得的最长随访期收集有关生命状态、再次PCI、收缩性心力衰竭、中风或Q波心肌梗死的数据。采用Cox比例风险回归评估死亡率的独立预测因素。共有831例患者接受了平均4年的随访。平均年龄为66±10岁。近40%为女性，50%患有糖尿病。平均随访间隔为4年，在此期间42例患者死亡（Kaplan-Meier率，4.3%[四分位间距，3.0-6.2%]）。死亡患者的PCI-SYNTAX II评分显著高于存活患者（分别为43±12和32±12；P<0.001）。SYNTAX II评分是平均随访4年时与死亡相关的唯一变量（每1分的风险比，1.05[95%置信区间，1.03-1.08]；P<0.001）。
纳入血管造影和临床参数的SYNTAX II评分是对 “真实世界” 患者进行风险分层和预测4年死亡率的有用工具。
