Department of Cardiology, National University of Ireland, Galway, Galway, Ireland.
Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
JACC Cardiovasc Interv. 2022 Jun 27;15(12):1231-1242. doi: 10.1016/j.jcin.2022.04.025. Epub 2022 May 17.
Percutaneous coronary intervention (PCI) of bifurcation lesions is associated with higher rates of adverse events, and currently it is unclear whether PCI or coronary artery bypass grafting (CABG) is the safer treatment for these patients at very long-term follow-up.
The aim of this study was to investigate the impact of bifurcation lesions on individual predicted and observed all-cause 10-year mortality in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial.
In the SYNTAXES (SYNTAX Extended Survival) study, 10-year observed and individual predicted mortality derived from the SYNTAX score 2020 (SS-2020) was compared between patients with ≥1 bifurcation (n = 1,300) and those with no bifurcations (n = 487).
Among patients treated with PCI, patients with >1 bifurcation lesion compared with those without bifurcation lesions had a significantly higher risk for all-cause death (19.8% vs 30.1%; HR: 1.55; 95% CI: 1.12-2.14; P = 0.007), whereas following CABG, mortality was similar in patients with and those without bifurcation lesions (23.3% vs 23.0%; HR: 0.81; 95% CI: 0.59-1.12; P = 0.207; P = 0.006). In PCI patients, a 2-stent vs a 1-stent technique was associated with higher mortality (33.3% vs 25.9%; HR: 1.51; 95% CI: 1.06-2.14; P = 0.021). According to the SS-2020, among those with ≥1 bifurcation, there was equipoise for all-cause mortality between PCI and CABG in 2 quartiles of the population, whereas CABG was superior to PCI in the 2 remaining quartiles.
Bifurcation lesions require special attention from the heart team, considering the higher 10-year all-cause mortality associated with PCI. Careful evaluation of bifurcation lesion complexity and calculation of individualized 10-year prognosis using the SS-2020 may therefore be helpful in decision making. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES], NCT03417050; Taxus Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX], NCT00114972).
经皮冠状动脉介入治疗（PCI）分叉病变与更高的不良事件发生率相关，目前尚不清楚对于这些患者在非常长期随访时，PCI 或冠状动脉旁路移植术（CABG）是更安全的治疗方法。
本研究旨在探讨分叉病变对 SYNTAX 试验中个体预测和观察到的 10 年全因死亡率的影响。
在 SYNTAXES（SYNTAX 延长生存）研究中，比较了有≥1 个分叉（n=1300）和无分叉（n=487）患者的 SYNTAX 评分 2020（SS-2020）预测的 10 年观察到和个体预测的死亡率。
在接受 PCI 治疗的患者中，与无分叉病变患者相比，有>1 个分叉病变患者的全因死亡风险显著更高（19.8%比 30.1%；HR：1.55；95%CI：1.12-2.14；P=0.007），而接受 CABG 后，有分叉病变和无分叉病变患者的死亡率相似（23.3%比 23.0%；HR：0.81；95%CI：0.59-1.12；P=0.207；P=0.006）。在 PCI 患者中，2 支架技术与 1 支架技术相比死亡率更高（33.3%比 25.9%；HR：1.51；95%CI：1.06-2.14；P=0.021）。根据 SS-2020，在有≥1 个分叉的患者中，在人群的 2 个四分位数中，PCI 和 CABG 的全因死亡率存在平衡，而在其余 2 个四分位数中，CABG 优于 PCI。
分叉病变需要心脏团队特别关注，因为与 PCI 相关的 10 年全因死亡率更高。因此，仔细评估分叉病变的复杂性并使用 SS-2020 计算个体化 10 年预后可能有助于决策。（紫杉醇药物洗脱支架与心脏手术的协同作用：SYNTAX 延长生存[SYNTAXES]，NCT03417050；Taxus 药物洗脱支架与冠状动脉旁路移植术治疗狭窄动脉[SYNTAX]，NCT00114972）。
