Department of Cardiology (G.W., H.V.-A., R.K.), Rabin Medical Center, Petach-Tikva, Israel.
Sackler school of Medicine, Tel-Aviv University, Israel (G.W., A.S., Y.D.B., E.R., A.A., A.F., H.V.-A., R.K., I.G., R.K.).
Circ Cardiovasc Interv. 2021 Jan;14(1):e009686. doi: 10.1161/CIRCINTERVENTIONS.120.009686. Epub 2021 Jan 11.
Practice guidelines emphasize the role of the SYNTAX score (SS; Synergy Between PCI With TAXUS and Cardiac Surgery) in choosing between percutaneous coronary intervention and coronary artery bypass graft surgery in cases of complex coronary artery disease. There is paucity of data on the implementation of these recommendations in daily practice, and on the consequences of guideline discordant revascularization.
This was a retrospective analysis of a prospective national survey of consecutive real world patients undergoing coronary revascularization for complex coronary artery disease according to decisions of local heart team at each center. SS was calculated at a dedicated CoreLab, and patients were classified as heart team/guidelines agreement/discordant.
Nine hundred seventy-nine patients (571 percutaneous coronary intervention and 408 coronary artery bypass graft) were included. Mean age was 65 years and the mean SS was 22. Heart team/guidelines discordance occurred in 170 (17.3%) patients. Independent predictors of heart team/guidelines discordance were age, admission to a center with no cardiac surgery service, SS, and previous percutaneous coronary intervention/myocardial infarction. A multivariate model based on these characteristics had a C statistic of 0.83. Thirty-day outcomes were similar in the agreement/discordance groups, however, heart team/guidelines discordance was associated with a significant increase in 3 year mortality (17.6% versus 8.4%; hazard ratio, 2.05; =0.002) after multivariate adjustment.
Heart team/guidelines discordance is not infrequent in real world patients with complex coronary artery disease undergoing revascularization. This is more likely to occur in elderly patients, those with more complex coronary disease (as determined by the SS), and those treated at centers with no cardiac surgery service. These patients have a higher risk for mid-term mortality.
实践指南强调 SYNTAX 评分（SS；PCI 与 Taxus 联合心脏手术的协同作用）在选择复杂冠状动脉疾病患者进行经皮冠状动脉介入治疗和冠状动脉旁路移植术时的作用。关于这些建议在日常实践中的实施情况以及指南不一致的血运重建的后果的数据很少。
这是一项对每个中心的当地心脏团队根据决定对复杂冠状动脉疾病进行冠状动脉血运重建的连续真实世界患者的前瞻性全国调查的回顾性分析。SS 在专用的核心实验室进行计算，患者被分为心脏团队/指南一致/不一致。
共纳入 979 例患者（571 例经皮冠状动脉介入治疗和 408 例冠状动脉旁路移植术）。平均年龄为 65 岁，平均 SS 为 22。心脏团队/指南不一致发生在 170 例（17.3%）患者中。心脏团队/指南不一致的独立预测因素是年龄、入住无心脏手术服务的中心、SS 和先前的经皮冠状动脉介入治疗/心肌梗死。基于这些特征的多变量模型的 C 统计量为 0.83。在一致性/不一致性组中，30 天结局相似，但多变量调整后，心脏团队/指南不一致与 3 年死亡率显著增加相关（17.6%对 8.4%；危险比，2.05；=0.002）。
在接受血运重建的复杂冠状动脉疾病真实世界患者中，心脏团队/指南不一致并不少见。这种情况更可能发生在老年患者、SS 确定的更复杂的冠状动脉疾病患者以及无心脏手术服务的中心治疗的患者中。这些患者中期死亡率较高。
