SYNTAX 评分对左主干冠状动脉疾病血运重建后 10 年结局的影响。
Impact of SYNTAX Score on 10-Year Outcomes After Revascularization for Left Main Coronary Artery Disease.
机构信息
Division of Cardiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
出版信息
JACC Cardiovasc Interv. 2020 Feb 10;13(3):361-371. doi: 10.1016/j.jcin.2019.10.020.
OBJECTIVES
The aim of this study was to investigate the long-term impact of SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SS) on differential outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) disease.
BACKGROUND
The very long term prognostic effect of SS on mortality and major cardiovascular events after LMCA revascularization is still undetermined.
METHODS
In the MAIN-COMPARE (Ten-Year Outcomes of Stents Versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease) registry, patients with baseline SS measurements were analyzed. The 10-year rates of all-cause mortality, the composite of death, Q-wave myocardial infarction, or stroke, and target vessel revascularization after PCI or CABG were compared according to baseline SS.
RESULTS
Among 1,580 patients with baseline SS, 547 patients (34.6%) had low SS (≤22), 350 (22.2%) had intermediate SS (23 to 32), and 683 (43.2%) had high SS (≥33). In patients with low to intermediate SS, the adjusted 10-year risks for death and serious composite outcome were similar between the PCI group and the CABG group. However, in patients with high SS, PCI with stenting, compared with CABG, was associated with a higher risk for death (hazard ratio: 1.39; 95% confidence interval: 1.00 to 1.92; p = 0.048) and serious composite outcome (hazard ratio: 1.27; 95% confidence interval: 0.94 to 1.74; p = 0.123). In each revascularization group, conventional tertiles of SS had a differential prognostic impact on 10-year clinical outcomes in the PCI arm but not in the CABG arm.
CONCLUSIONS
In this 10-year extended follow-up of patients undergoing LMCA revascularization, CABG showed a clear prognostic benefit over PCI in patients with high anatomic complexity measured by SS at baseline. The discriminative capacity of SS on long-term outcomes was relevant in the PCI group but not in the CABG group. (Ten-Year Outcomes of Stents Versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease [MAIN-COMPARE]; NCT02791412).
目的
本研究旨在探讨 SYNTAX（经皮冠状动脉介入治疗与心脏手术联合治疗）评分（SS）对左主干冠状动脉（LMCA）疾病经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）后差异结局的长期影响。
背景
SS 对 LMCA 血运重建后死亡率和主要心血管事件的非常长期预后影响仍不确定。
方法
在 MAIN-COMPARE（支架与冠状动脉旁路移植术治疗左主干冠状动脉疾病的 10 年结果）注册研究中，对基线时测量 SS 的患者进行了分析。根据基线 SS 比较了 PCI 或 CABG 后全因死亡率、死亡、Q 波心肌梗死或卒中和靶血管血运重建的复合终点 10 年发生率。
结果
在 1580 例基线 SS 患者中，547 例（34.6%）SS 低（≤22），350 例（22.2%）SS 中（23 至 32），683 例（43.2%）SS 高（≥33）。在低至中 SS 患者中，PCI 组与 CABG 组的 10 年死亡和严重复合结局的调整风险相似。然而，在高 SS 患者中，与 CABG 相比，PCI 支架置入与死亡（风险比：1.39；95%置信区间：1.00 至 1.92；p=0.048）和严重复合结局（风险比：1.27；95%置信区间：0.94 至 1.74；p=0.123）的风险更高。在每个血运重建组中，SS 的传统三分位数对 PCI 组 10 年临床结局具有不同的预后影响，但 CABG 组则没有。
结论
在这项对接受 LMCA 血运重建的患者进行的 10 年扩展随访中，与 PCI 相比，基线时 SS 测量显示解剖复杂性高的患者 CABG 具有明显的预后优势。SS 对长期结局的区分能力在 PCI 组中是相关的，但在 CABG 组中则不然。（支架与冠状动脉旁路移植术治疗左主干冠状动脉疾病的 10 年结果 [MAIN-COMPARE]；NCT02791412）。
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