Yan Liqiu, Han Dong, Wang Yabin, Li Sulei, Yan Wei, Guo Nan, Mao Ying, Yang Qian, Li Mengyao, Lei Yumeng, Zhang Shuaiyong, Cao Feng
Department of Cardiology, the Affiliated Dongguan Songshan Lake Central Hospital, Guangdong Medical University, 523326 Dongguan, Guangdong, China.
The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853 Beijing, China.
Rev Cardiovasc Med. 2024 Oct 22;25(10):371. doi: 10.31083/j.rcm2510371. eCollection 2024 Oct.
The SYNTAX score II (SS II) has earned widespread recognition for use on individuals with coronary artery disease (CAD) due to its reliable predictions of 4-year all-cause mortality (ACM). This research focuses on substantiating the prognostic significance of using the SS II for patients experiencing concurrent chronic renal insufficiency (CRI) and CAD who have undergone percutaneous coronary intervention (PCI).
This study retrospectively examined 2468 patients with concurrent CAD and CRI who underwent PCI. Based on their SS II, these participants were sorted into low-, medium-, and high-risk groups and monitored over a median of three years. The evaluation of the predictive precision of different SYNTAX scores for clinical outcomes in patients with CRI after PCI involved using time-dependent receiver operating characteristic (ROC) curves. These included the standard SS (SS), SS II, clinical SS (CSS), and residual SS (rSS). The primary outcomes were ACM and cardiac mortality (CM), while the secondary outcomes covered major adverse cardiovascular and cerebrovascular events (MACCEs), stroke, unplanned revascularization, and myocardial infarction (MI).
Higher 5-year cumulative incidences of MACCEs, MI, CM, and ACM were observed significantly in patients in the high SS II category relative to those in the low and medium SS II categories. Multivariable Cox regression analysis confirmed that the SS II independently predicts ACM, CM, MI, and MACCEs as a prognostic marker. Additionally, the analysis of the time-dependent ROC curve demonstrated that the areas under the curve (AUC) for predicting CM and ACM were 0.772 and 0.767, respectively, which are superior to those of other SYNTAX scores ( < 0.05).
As an independent predictor, the SS II is notable for its ability to forecast long-term adverse outcomes, including MACCEs, CM, ACM, and MI. For patients with coexisting CAD and CRI undergoing PCI, it provides significantly improved prognostic accuracy for 5-year ACM and CM compared to other SYNTAX scores.
SYNTAX评分II（SS II）因其对冠心病（CAD）患者4年全因死亡率（ACM）的可靠预测而在CAD患者中得到广泛认可。本研究旨在证实对于接受经皮冠状动脉介入治疗（PCI）的合并慢性肾功能不全（CRI）和CAD的患者，使用SS II的预后意义。
本研究回顾性分析了2468例接受PCI的合并CAD和CRI的患者。根据他们的SS II，将这些参与者分为低、中、高风险组，并进行了为期三年的中位数随访。使用时间依赖性受试者工作特征（ROC）曲线评估不同SYNTAX评分对PCI术后CRI患者临床结局的预测精度。这些评分包括标准SYNTAX评分（SS）、SS II、临床SYNTAX评分（CSS）和残余SYNTAX评分（rSS）。主要结局为ACM和心脏死亡率（CM），次要结局包括主要不良心血管和脑血管事件（MACCEs）、中风、非计划血管重建和心肌梗死（MI）。
与低和中SS II类别的患者相比，高SS II类别的患者中MACCEs、MI、CM和ACM的5年累积发生率显著更高。多变量Cox回归分析证实，SS II作为预后标志物可独立预测ACM、CM、MI和MACCEs。此外，时间依赖性ROC曲线分析表明，预测CM和ACM的曲线下面积（AUC）分别为0.772和0.767，优于其他SYNTAX评分（P<0.05）。
作为一个独立的预测指标，SS II以其预测包括MACCEs、CM、ACM和MI在内的长期不良结局的能力而著称。对于同时患有CAD和CRI并接受PCI的患者，与其他SYNTAX评分相比，它在5年ACM和CM方面提供了显著提高的预后准确性。
