Lin Shen, Zhang Heng, Chen Si-Peng, Rao Chen-Fei, Wu Fan, Zhou Fa-Jun, Wang Yun, Yan Hong-Bing, Dou Ke-Fei, Wu Yong-Jian, Tang Yi-Da, Xie Li-Hua, Guan Chang-Dong, Xu Bo, Zheng Zhe
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
Chin Med J (Engl). 2020 Jun 5;133(11):1276-1284. doi: 10.1097/CM9.0000000000000827.
Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization. Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a comprehensive system to evaluate the complexity of the overall lesions. We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease (CAD).
In this single-center, historical control study, patients with stable CAD with coronary lesion stenosis ≥50% were consecutively recruited. During the control period, SYNTAX scores were calculated by treating cardiologists. During the intervention period, SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making. The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.
A total of 3245 patients were enrolled and assigned to the control group (08/2016-03/2017, n = 1525) or the intervention group (03/2017-09/2017, n = 1720). For SYNTAX score tertiles, 17.9% patients were overestimated and 4.3% were underestimated by cardiologists in the control group. After adjustment, inappropriate revascularization significantly decreased in the intervention group compared with the control group (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.73-0.95; P = 0.007). Both inappropriate percutaneous coronary intervention (adjusted OR: 0.82; 95% CI: 0.74-0.92; P < 0.001) and percutaneous coronary intervention utilization (adjusted OR: 0.88; 95% CI: 0.79-0.98; P = 0.016) decreased significantly in the intervention group. There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.
Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.
Nos. NCT03068858 and NCT02880605; https://www.clinicaltrials.gov.
据报道，冠状动脉造影解读不准确会导致不适当的血运重建。经皮冠状动脉介入治疗与心脏手术协同作用（SYNTAX）评分是评估整体病变复杂性的综合系统。我们假设，图像分析人员提供的实时SYNTAX评分反馈可能会纠正估计错误，并提高稳定型冠状动脉疾病（CAD）患者血运重建的适当性。
在这项单中心历史对照研究中，连续招募冠状动脉病变狭窄≥50%的稳定型CAD患者。在对照期，由治疗心脏病专家计算SYNTAX评分。在干预期，冠状动脉造影后立即由图像分析人员计算SYNTAX评分，并实时提供给心脏病专家以辅助决策。主要结局是根据中国冠状动脉血运重建适宜性标准判定为不适当的血运重建。
共纳入3245例患者，分为对照组（2016年8月至2017年3月，n = 1525）和干预组（2017年3月至2017年9月，n = 1720）。对于SYNTAX评分三分位数，对照组中心脏病专家高估了17.9%的患者，低估了4.3%的患者。调整后，干预组与对照组相比，不适当血运重建显著减少（调整后的优势比[OR]：0.83；95%置信区间[CI]：0.73 - 0.95；P = 0.007）。干预组中不适当的经皮冠状动脉介入治疗（调整后的OR：0.82；95% CI：0.74 - 0.92；P < 0.001）和经皮冠状动脉介入治疗的使用率（调整后的OR：0.88；95% CI：0.79 - 0.98；P = 0.016）均显著降低。对照组和干预组1年不良心脏事件无显著差异。
实时SYNTAX评分反馈显著减少了稳定型CAD患者不适当的冠状动脉血运重建。
编号NCT03068858和NCT02880605；https://www.clinicaltrials.gov。
