Yoon Jae Yong, Lee Jang Hoon, Kim Hong Nyun, Kim Namkyun, Jang Se Yong, Bae Myung Hwan, Yang Dong Heon, Park Hun Sik, Cho Yongkeun
Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, South Korea.
Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea.
Front Cardiovasc Med. 2022 Sep 23;9:912286. doi: 10.3389/fcvm.2022.912286. eCollection 2022.
Simple and effective risk models incorporating biomarkers associated with left main coronary artery (LMCA) stenosis are limited. This study aimed to validate the novel Bio-Clinical SYNTAX score (Bio-CSS) incorporating N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with LMCA stenosis.
Patients who underwent percutaneous coronary intervention (PCI) for LMCA stenosis using a drug-eluting stent ( = 275) were included in the study. We developed the Bio-CSS incorporating NT-proBNP and validated the ability of the Bio-CSS to predict major adverse cardiac events (MACEs) and compared its performance to that of the SYNTAX score (SS) and SS II. The MACEs were defined as death, non-fatal myocardial infarction (MI), and repeat revascularizations.
The Bio-CSS (34.7 ± 18.3 vs. 51.9 ± 28.4, < 0.001), as well as SS (23.6 ± 7.3 vs. 26.7 ± 8.1, = 0.003) and SS II (29.4 ± 9.9 vs. 36.1 ± 12.8, < 0.001), was significantly higher in patients with MACEs. In the Cox proportional hazards model, the log Bio-CSS (hazard ratio 8.31, 95% CI 1.84-37.55) was an independent prognostic factor for MACEs after adjusting for confounding variables. In the receiver operating characteristic curves, the area under the curve of the Bio-CSS was significantly higher compared to those of SS (0.608 vs. 0.706, = 0.001) and SS II (0.655 vs. 0.706, = 0.026). Patients were categorized into the three groups based on the tertiles of the Bio-CSS. Patients in the highest tertile of the Bio-CSS had significantly higher MACEs compared to those in the lower two tertiles (log-rank < 0.001).
In patients who underwent PCI for LMCA stenosis, the novel Bio-CSS improved the discrimination accuracy of established combined scores, such as SS and SS II. The addition of NT-proBNP to the clinical and angiographic findings in the Bio-CSS could potentially provide useful long-term prognostic information in these patients.
包含与左主干冠状动脉（LMCA）狭窄相关生物标志物的简单有效的风险模型有限。本研究旨在验证纳入N末端B型脑钠肽原（NT-proBNP）的新型生物临床SYNTAX评分（Bio-CSS）在LMCA狭窄患者中的有效性。
纳入275例使用药物洗脱支架对LMCA狭窄进行经皮冠状动脉介入治疗（PCI）的患者。我们开发了纳入NT-proBNP的Bio-CSS，并验证其预测主要不良心脏事件（MACE）的能力，并将其性能与SYNTAX评分（SS）和SS II进行比较。MACE定义为死亡、非致命性心肌梗死（MI）和再次血运重建。
发生MACE的患者的Bio-CSS（34.7±18.3对51.9±28.4，P<0.001）、SS（23.6±7.3对26.7±8.1，P=0.003）和SS II（29.4±9.9对36.1±12.8，P<0.001）显著更高。在Cox比例风险模型中，经混杂变量校正后，Bio-CSS的对数（风险比8.31，95%CI 1.84-37.55）是MACE的独立预后因素。在受试者工作特征曲线中，Bio-CSS的曲线下面积显著高于SS（0.608对0.706，P=0.001）和SS II（0.655对0.706，P=0.026）。根据Bio-CSS的三分位数将患者分为三组。Bio-CSS最高三分位数组的患者的MACE显著高于较低的两个三分位数组（对数秩检验P<0.001）。
在接受PCI治疗的LMCA狭窄患者中，新型Bio-CSS提高了如SS和SS II等既定综合评分的鉴别准确性。在Bio-CSS中，将NT-proBNP添加到临床和血管造影结果中可能为这些患者提供有用的长期预后信息。
