Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut, 71526, Egypt.
BMC Cardiovasc Disord. 2024 Jan 23;24(1):68. doi: 10.1186/s12872-023-03657-2.
The residual burden of coronary artery disease (CAD) after percutaneous coronary intervention (PCI) drew a growing interest. The residual SYNTAX Score (rSS) was a strong prognostic factor of adverse events and all-cause mortality in patients who underwent PCI. In addition, the SYNTAX Revascularization Index (SRI), a derivative of rSS, was used to figure out the treated proportion of CAD and could be used as a prognostic utility in PCI for patients with multi-vessel disease (MVD).
We aimed at the assessment of the use of rSS and the SRI as predictors of in-hospital outcomes and up to two-year cumulative follow-up outcomes in patients with MVD who had PCI for the treatment of ST-Elevation Myocardial Infarction (STEMI) or Non-STEMI (NSTEMI).
We recruited 149 patients who had either STEMI or NSTEMI while having MVD and received treatment with PCI. We divided them into tertiles based on their rSS and SRI values. We calculated baseline SYNTAX Score (bSS) and rSS using the latest version of the calculator on the internet, and we used both scores to calculate SRI. The study end-points were In-hospital composite Major Adverse Cardiovascular Events (MACE) and its components, in-hospital death, and follow-up cumulative MACE up to 2 years.
Neither rSS nor SRI were significant predictors of in-hospital adverse events, while female sex, hypertension, and left ventricular ejection fraction were independent predictors of in-hospital MACE. At the two-year follow-up, Kaplan-Meyer analysis showed a significantly increased incidence of MACE within the third rSS tertile (rSS > 12) compared to other tertiles (log rank p = 0.03). At the same time, there was no significant difference between the three SRI tertiles. Unlike SRI, rSS was a significant predictor of cumulative MACE on univariate Cox regression (HR = 1.037, p < 0.001). On multivariate Cox regression, rSS was a significant independent predictor of two-year cumulative MACE (HR = 1.038, p = 0.0025) along with female sex, hypertension, and left ventricular ejection fraction. We also noted that all patients with complete revascularization survived well throughout the entire follow-up period.
Neither rSS nor SRI could be good predictors of in-hospital MACE, while the rSS was a good predictor of MACE at two-year follow-up. Patients with rSS values > 12 had a significantly higher incidence of cumulative MACE after 2 years. The best prognosis was achieved with complete revascularization.
经皮冠状动脉介入治疗（PCI）后冠状动脉疾病（CAD）的残余负担引起了越来越多的关注。残余 SYNTAX 评分（rSS）是接受 PCI 治疗的患者不良事件和全因死亡率的强有力预后因素。此外，rSS 的衍生指标 SYNTAX 血运重建指数（SRI）用于计算 CAD 的治疗比例，并可作为多血管疾病（MVD）患者 PCI 的预后指标。
我们旨在评估 rSS 和 SRI 作为预测因子的作用，这些预测因子用于预测 MVD 患者因 ST 段抬高型心肌梗死（STEMI）或非 ST 段抬高型心肌梗死（NSTEMI）而行 PCI 治疗的住院期间和两年累积随访结局。
我们招募了 149 名患有 MVD 且因 STEMI 或 NSTEMI 而接受 PCI 治疗的患者。我们根据 rSS 和 SRI 值将他们分为三组。我们使用互联网上最新版本的计算器计算基线 SYNTAX 评分（bSS）和 rSS，并使用这两个评分计算 SRI。研究终点是住院期间复合主要不良心血管事件（MACE）及其组成部分、住院期间死亡以及随访至 2 年的累积 MACE。
rSS 和 SRI 均不是住院期间不良事件的显著预测因子，而女性、高血压和左心室射血分数是住院期间 MACE 的独立预测因子。在两年的随访中，Kaplan-Meier 分析显示，与其他两组相比，rSS 第三组（rSS＞12）的 MACE 发生率显著增加（对数秩检验 p=0.03）。同时，三组 SRI 之间没有显著差异。与 SRI 不同，rSS 是单变量 Cox 回归中累积 MACE 的显著预测因子（HR=1.037，p＜0.001）。多变量 Cox 回归分析显示，rSS 是两年累积 MACE 的显著独立预测因子（HR=1.038，p=0.0025），同时还有女性、高血压和左心室射血分数。我们还注意到，所有完全血运重建的患者在整个随访期间均存活良好。
rSS 和 SRI 均不能很好地预测住院期间的 MACE，而 rSS 是两年随访时 MACE 的良好预测因子。rSS 值＞12 的患者在 2 年后累积 MACE 的发生率显著升高。完全血运重建可获得最佳预后。
