Obeid Slayman, Frangieh Antonio H, Räber Lorenz, Yousif Nooraldaem, Gilhofer Thomas, Yamaji Kyohei, Jaguszewski Milosz, Aghlmandi Soheila, Adams James, Bockhorn Yannik, Templin Christian, Stähli Barbara E, Jüni Peter, Rodondi Nicolas, Mach François, Roffi Marco, Windecker Stephan, Maier Willibald, Nietlispach Fabian, Matter Christian M, Klingenberg Roland, Lüscher Thomas F
University Heart Center, Department of Cardiology, Zurich, Switzerland.
Cardiovascular Center, Department of Cardiology, University Hospital Bern, Bern, Switzerland.
Cardiol Res Pract. 2018 Sep 25;2018:9762176. doi: 10.1155/2018/9762176. eCollection 2018.
To assess the incremental prognostic value of SYNTAX score II (SxSII) as compared to anatomical SYNTAX Score (SxS) and GRACE risk score in patients with acute coronary syndromes who underwent percutaneous coronary intervention.
SxSII and SxS were determined in 734 ACS patients. Patients were enrolled in the prospective Special Program University Medicine ACS and the COMFORTABLE AMI cohorts and later on stratified according to tertiles of SxSII (SxSII ≤21.5 (=245), SxSII 21.5-30.6 (=245), and SxSII ≥30.6 (=244). The primary endpoint of adjudicated all-cause mortality and secondary endpoints of MACE (cardiac death, repeat revascularization, and myocardial infarction) and MACCE (all-cause mortality, cerebrovascular events, MI, and repeat revascularization) were determined at 1-year follow-up. SxSII provided incremental predictive information for risk stratification when compared to SxS and GRACE risk score (AUC 0.804, 95% CI 0.77-0.84, < 0.001 versus 0.67, 95% CI 0.63-0.72, =0.007 versus 0.69, 95% CI 0.6-0.8, =0.002), respectively. In a multivariable Cox regression analysis, we found that unlike SxS (adjusted HR 1.013, 95% CI (0.96-1.07), =0.654), SxSII was significantly associated with all-cause mortality (HR = 1.095, 95% CI (1.06-1.11), < 0.001). This was also true for the prediction of both secondary outcomes MACE (=60) and MACCE (=70) with an adjusted HR = 1.055, 95% CI (1.03-1.08), < 0.001, and HR = 1.065, 95% CI (1.04-1.09), < 0.001.
In patients with ACS who underwent PCI, SxSII is an independent predictor of mortality during 1-year follow-up. SxSII shows superiority in discriminating risk compared to conventional SxS and GRACE for all-cause mortality.
评估与解剖学SYNTAX评分（SxS）和GRACE风险评分相比，SYNTAX评分II（SxSII）对接受经皮冠状动脉介入治疗的急性冠状动脉综合征患者的增量预后价值。
对734例急性冠状动脉综合征（ACS）患者测定SxSII和SxS。患者入选前瞻性特殊项目大学医学ACS和舒适型急性心肌梗死队列，随后根据SxSII三分位数进行分层（SxSII≤21.5（=245例），SxSII 21.5 - 30.6（=245例），SxSII≥30.6（=244例））。在1年随访时确定判定的全因死亡率的主要终点以及主要不良心血管事件（MACE，包括心源性死亡、再次血运重建和心肌梗死）和主要不良心血管和脑血管事件（MACCE，包括全因死亡率、脑血管事件、心肌梗死和再次血运重建）的次要终点。与SxS和GRACE风险评分相比，SxSII为风险分层提供了增量预测信息（AUC分别为0.804，95%可信区间0.77 - 0.84，P<0.001；与0.67，95%可信区间0.63 - 0.72，P = 0.007；与0.69，95%可信区间0.6 - 0.8，P = 0.002相比）。在多变量Cox回归分析中，我们发现与SxS不同（调整后HR 1.013，95%可信区间（（0.96 - 1.07），P = 0.654），SxSII与全因死亡率显著相关（HR = 1.095，95%可信区间（1.06 - 1.11），P<小于0.001）。对于次要结局MACE（P<0.001）和MACCE（P<0.001）的预测也是如此，调整后HR分别为1.055，95%可信区间（1.03 - 1.08）和HR = 1.065，95%可信区间（1.04 - 1.09）。
在接受PCI的ACS患者中，SxSII是1年随访期间死亡率的独立预测因子。与传统的SxS和GRACE相比，SxSII在区分全因死亡率风险方面具有优越性。
