Morici Nuccia, Alicandro Gianfranco, Ferri Luca A, Piatti Luigi, Grosseto Daniele, Sganzerla Paolo, Tortorella Giovanni, Ferrario Maurizio, Crimi Gabriele, Bossi Irene, Tondi Stefano, Petronio Anna Sonia, Mariani Matteo, Toso Anna, Ravera Amelia, Corrada Elena, Cao Davide, Di Ascenzo Leonardo, La Vecchia Carlo, De Servi Stefano, Savonitto Stefano
Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.
CJC Open. 2020 Mar 20;2(4):236-243. doi: 10.1016/j.cjco.2020.03.005. eCollection 2020 Jul.
The residual burden of coronary artery disease after percutaneous coronary intervention (PCI) has been associated with worse ischemic outcome. However, data are conflicting in elderly patients. The aim of our study was to verify the incremental value of the residual ergy Between Percutaneous Coronary Intervention With us and Cardiac Surgery (SYNTAX) score (rSS) over clinical variables and baseline SYNTAX score (bSS) in predicting 1-year mortality or cardiovascular events.
A post hoc analysis of data collected in the Elderly-ACS 2 multicenter randomized trial was performed. We included 630 patients aged > 75 years with multivessel coronary disease undergoing PCI for acute coronary syndrome (ACS). The primary outcome was a composite of death, recurrent myocardial infarction, and stroke at 1-year follow up. Change in c-statistic and standardized net benefit were used to evaluate the incremental value of the rSS.
Event rates were significantly higher in patients with incomplete revascularization (rSS > 8). When the rSS was included in a core Cox regression model containing age, previous myocardial infarction, and ACS type, the hazard ratio for patients with score values > 8 was 2.47 (95% confidence interval, 1.51-4.06). However, the core model with rSS did not increase the c-statistic compared with the core model with the bSS (from 0.69 to 0.70) and gave little incremental value in the standardized net benefit.
In elderly patients with ACS with multivessel disease undergoing PCI, incomplete revascularization was associated with worse outcome at 1-year follow-up. However, there was no clear incremental value of the rSS in the prediction of 1-year adverse outcome compared with a model including clinical variables and bSS.
经皮冠状动脉介入治疗（PCI）后冠状动脉疾病的残余负担与更差的缺血结局相关。然而，老年患者的数据存在矛盾。我们研究的目的是验证残余SYNTAX评分（rSS）相对于临床变量和基线SYNTAX评分（bSS）在预测1年死亡率或心血管事件方面的增量价值。
对老年急性冠状动脉综合征（Elderly-ACS 2）多中心随机试验收集的数据进行事后分析。我们纳入了630例年龄>75岁、患有多支冠状动脉疾病且因急性冠状动脉综合征（ACS）接受PCI的患者。主要结局是1年随访时死亡、复发性心肌梗死和中风的复合结局。采用c统计量变化和标准化净效益来评估rSS的增量价值。
血管重建不完全（rSS>8）的患者事件发生率显著更高。当将rSS纳入包含年龄、既往心肌梗死和ACS类型的核心Cox回归模型时，评分值>8的患者的风险比为2.47（95%置信区间，1.51 - 4.06）。然而，与包含bSS的核心模型相比，包含rSS的核心模型并未增加c统计量（从0.69增至0.70），且在标准化净效益方面增量价值很小。
在接受PCI的多支血管疾病老年ACS患者中，血管重建不完全与1年随访时更差的结局相关。然而，与包含临床变量和bSS的模型相比，rSS在预测1年不良结局方面没有明确的增量价值。
