Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Washington University School of Medicine, St. Louis, MO, USA.
J Cardiothorac Surg. 2021 Sep 3;16(1):248. doi: 10.1186/s13019-021-01616-6.
The objective of this study was to evaluate the association of SYNTAX scores I, II, and residual with cardiovascular outcomes of patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and compare both procedures in a long-term follow-up.
This is a retrospective single-center study from the MASS registry at the Heart Institute of the University of São Paulo, Brazil in which 969 patients with stable coronary artery disease undergoing CABG (559) or PCI (410) were included. We assessed the SYNTAX scores I, II and residual in both interventions. Clinical endpoints were the first occurrence of a composite of overall death, myocardial infarction, stroke, or repeat revascularization (MACCE) and the total occurrence of each component of MACCE.
In the CABG sample, SSI had a median of 23 (IQR 17-29.5), median SSII of 25.4 (IQR 19.2-32.8), and median rSS of 2 (IQR 0-6.5); in PCI SSI had a median of 14 (IQR 10-19.1), median SSII of 28.7 (IQR 23-34.2), and median rSS of 4.7 (IQR 0-9). Total of 174 events were documented and CABG patients had a lower rate of MACCE (15.6% vs. 21.2%; adjusted HR 1.98; 95% CI 1.13-3.47; P = 0.016) and repeat revascularization (3.8% vs. 11.5%; adjusted HR 4.35; CI 95% 1.74-10.85; P = 0.002) compared with PCI. No SYNTAX score tertile found a difference in death rate between procedures. In a multivariate analysis, the rSS was an independent predictor for MACCE (HR 1.04; 95% CI 1.01-1.06; P = 0.001). Regarding death, the only independent predictors were ejection fraction and renal function.
Surgical revascularization resulted in a more complete revascularization and lower rates of major cardiac or cerebrovascular events in a long-term follow-up. Also, grading the incompleteness of revascularization through the residual SYNTAX score identified a higher event rate, suggesting that complete revascularization is associated with a better prognosis.
本研究旨在评估 SYNTAX 评分 I、II 和残余值与接受冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）的患者心血管结局的相关性，并在长期随访中比较这两种手术。
这是巴西圣保罗大学心脏研究所 MASS 注册中心的一项回顾性单中心研究，共纳入 969 例稳定性冠状动脉疾病患者，分别行 CABG（559 例）或 PCI（410 例）。我们评估了两种干预措施中的 SYNTAX 评分 I、II 和残余值。临床终点为全因死亡、心肌梗死、卒中和再次血运重建（MACCE）的复合首次发生，以及 MACCE 的每个组成部分的总发生。
在 CABG 样本中，SSI 的中位数为 23（IQR 17-29.5），SSII 的中位数为 25.4（IQR 19.2-32.8），rSS 的中位数为 2（IQR 0-6.5）；在 PCI 中，SSI 的中位数为 14（IQR 10-19.1），SSII 的中位数为 28.7（IQR 23-34.2），rSS 的中位数为 4.7（IQR 0-9）。共记录了 174 例事件，CABG 患者的 MACCE 发生率较低（15.6% vs. 21.2%；调整后的 HR 1.98；95%CI 1.13-3.47；P=0.016）和再次血运重建（3.8% vs. 11.5%；调整后的 HR 4.35；95%CI 1.74-10.85；P=0.002）低于 PCI。在多变量分析中，rSS 是 MACCE 的独立预测因子（HR 1.04；95%CI 1.01-1.06；P=0.001）。关于死亡，唯一的独立预测因子是射血分数和肾功能。
在长期随访中，手术血运重建可实现更完全的血运重建，并降低主要心脏或脑血管事件的发生率。此外，通过残余 SYNTAX 评分评估血运重建的不完全程度可确定更高的事件发生率，这表明完全血运重建与更好的预后相关。
