SYNTAXES 试验中术前生物标志物对 10 年死亡率的影响。
Impact of preprocedural biological markers on 10-year mortality in the SYNTAXES trial.
机构信息
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.
出版信息
EuroIntervention. 2022 Apr 22;17(18):1477-1487. doi: 10.4244/EIJ-D-21-00415.
BACKGROUND
Creatinine clearance (CrCl) is an independent determinant of mortality in predictive models of revascularisation outcomes for complex coronary artery disease.
AIMS
This study aimed to investigate the impact of preprocedural biological markers on 10-year mortality following coronary revascularisation.
METHODS
The SYNTAX Extended Survival (SYNTAXES) study evaluated the 10-year vital status follow-up of 1,800 patients with de novo three-vessel (3VD) and/or left main coronary artery disease (LMCAD) randomised to include percutaneous or surgical coronary revascularisation. The associations between mortality and preprocedural C-reactive protein (CRP), haemoglobin, HbA1c, CrCl, fasting triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were analysed.
RESULTS
Out of 1,800 patients, 460 patients died before the 10-year follow-up. CRP, HbA1c and CrCl with threshold values of ≥2 mg/L, ≥6% (42 mmol/mol) and <60 ml/min, respectively, were associated with 10-year all-cause death (adjusted hazard ratio [95% confidence interval]: 1.35 [1.01-1.82], 1.51 [1.16-1.95], and 1.46 [1.07-2.00], respectively). There was no significant interaction between the biological markers on all-cause mortality and the type of revascularisation. Preprocedural lipid markers were not significantly associated with 10-year all-cause death, but the non-use of statins was a determinant factor of worse prognosis (adjusted hazard ratio [95% confidence interval]: 1.68 [1.26-2.25]).
CONCLUSIONS
Preprocedural biomarkers, such as CRP and HbA1c, are associated with long-term mortality post revascularisation, regardless of the revascularisation technique. Conventional lipidic biomarkers associated with high-risk of cardiovascular events seem to be effectively mitigated by the long-term use of statins, whereas the non-use of statins was a factor of a worse prognosis, emphasising the importance of pharmacological treatment.
TRIAL REGISTRATION
SYNTAXES ClinicalTrials.gov: NCT03417050. SYNTAX ClinicalTrials.gov: NCT00114972.
背景
在复杂冠状动脉疾病血运重建结果的预测模型中，肌酐清除率（CrCl）是死亡率的独立决定因素。
目的
本研究旨在探讨术前生物标志物对冠状动脉血运重建后 10 年死亡率的影响。
方法
SYNTAX 扩展生存（SYNTAXES）研究评估了 1800 例新发三血管（3VD）和/或左主干冠状动脉疾病（LMCAD）患者的 10 年生存状态随访结果，这些患者被随机分为经皮或手术冠状动脉血运重建。分析死亡率与术前 C 反应蛋白（CRP）、血红蛋白、HbA1c、CrCl、空腹甘油三酯、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇之间的关系。
结果
在 1800 例患者中，460 例患者在 10 年随访前死亡。CRP、HbA1c 和 CrCl 的截断值分别为≥2mg/L、≥6%（42mmol/mol）和<60ml/min，与 10 年全因死亡相关（调整后的危险比[95%置信区间]：1.35[1.01-1.82]、1.51[1.16-1.95]和 1.46[1.07-2.00]）。生物标志物对全因死亡率的影响与血运重建类型之间没有显著的相互作用。术前脂质标志物与 10 年全因死亡无显著相关性，但他汀类药物的不使用是预后较差的决定因素（调整后的危险比[95%置信区间]：1.68[1.26-2.25]）。
结论
术前生物标志物如 CRP 和 HbA1c 与血运重建后长期死亡率相关，而与血运重建技术无关。与心血管事件高危相关的传统脂质生物标志物似乎可通过长期使用他汀类药物得到有效缓解，而他汀类药物的不使用则是预后较差的一个因素，强调了药物治疗的重要性。
试验注册
SYNTAXES ClinicalTrials.gov：NCT03417050。SYNTAX ClinicalTrials.gov：NCT00114972。
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