Heart Institute of the University of São Paulo Medical School, São Paulo, Brazil; Prevent Senior Institute, São Paulo, Brazil.
Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada.
J Am Coll Cardiol. 2018 Dec 11;72(23 Pt A):2826-2837. doi: 10.1016/j.jacc.2018.09.046.
Diabetes mellitus (DM) is associated with complex coronary artery disease (CAD), which in turn results in increased morbidity and mortality from cardiovascular disease.
This study sought to evaluate the utility of SYNTAX score (SS) for predicting future cardiovascular events in patients with DM and complex CAD undergoing either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).
The FREEDOM (Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease) trial randomized patients with DM and multivessel CAD to undergo either PCI with drug-eluting stents or CABG. The SS was calculated retrospectively by a core laboratory. The endpoint of hard cardiovascular events (HCE) was a composite of death from any cause, nonfatal myocardial infarction, and nonfatal stroke, while the endpoint of major adverse cardiac and cerebrovascular events (MACCE) was a composite of HCE and repeat revascularization.
A total of 1,900 patients were randomized to PCI (n = 953) or CABG (n = 947). The SS was considered an independent predictor of 5-year MACCE (hazard ratio per unit of SS: 1.02; 95% confidence interval: 1.00 to 1.03; p = 0.014) and HCE (hazard ratio per unit of SS: 1.03; 95% confidence interval: 1.01 to 1.04; p = 0.002) in the PCI cohort, but not in the CABG group. There was a higher incidence of MACCE in PCI patients with low, intermediate, and high SS compared with those who underwent CABG (36.6% vs. 25.9%, p = 0.02; 43.9% vs. 26.8%, p < 0.001; 48.7% vs. 29.7%, p = 0.003, respectively).
In DM patients with multivessel CAD, the complexity of CAD evaluated by the SS is an independent risk factor for MACCE and HCE only in patients undergoing PCI. The SS should not be utilized to guide the choice of coronary revascularization in patients with DM and multivessel CAD. (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450).
糖尿病（DM）与复杂的冠状动脉疾病（CAD）相关，这反过来又导致心血管疾病的发病率和死亡率增加。
本研究旨在评估 SYNTAX 评分（SS）在预测接受冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）的 DM 合并复杂 CAD 患者未来心血管事件中的作用。
FREEDOM（糖尿病患者的未来血运重建评估：多血管疾病的最佳治疗）试验将 DM 合并多血管 CAD 患者随机分为接受药物洗脱支架 PCI 或 CABG 治疗。SS 由核心实验室回顾性计算。硬心血管事件（HCE）终点为任何原因死亡、非致死性心肌梗死和非致死性卒中的复合终点，而主要不良心脏和脑血管事件（MACCE）终点为 HCE 和再次血运重建的复合终点。
共 1900 例患者随机分为 PCI（n=953）或 CABG（n=947）组。SS 被认为是 PCI 组 5 年 MACCE（每单位 SS 的风险比：1.02；95%置信区间：1.00 至 1.03；p=0.014）和 HCE（每单位 SS 的风险比：1.03；95%置信区间：1.01 至 1.04；p=0.002）的独立预测因素，但在 CABG 组中并非如此。与 CABG 组相比，SS 低、中、高的 PCI 患者 MACCE 发生率更高（36.6% vs. 25.9%，p=0.02；43.9% vs. 26.8%，p<0.001；48.7% vs. 29.7%，p=0.003）。
在 DM 合并多血管 CAD 患者中，SS 评估的 CAD 复杂性仅在接受 PCI 的患者中是 MACCE 和 HCE 的独立危险因素。SS 不应用于指导 DM 合并多血管 CAD 患者的冠状动脉血运重建选择。（两种治疗方法在糖尿病患者多血管冠状动脉疾病中的比较[FREEDOM]；NCT00086450）。
