Zhang Rui, Wu Shaoyu, Liu Qianqian, Guan Changdong, Wang Hao-Yu, Yuan Sheng, Xie Lihua, Huang Yunfei, Qiao Zheng, Liu Weida, Fu Rui, Feng Lei, Zhu Chenggang, Song Lei, Yin Dong, Dou Kefei
Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
Adv Sci (Weinh). 2025 Apr;12(14):e2415961. doi: 10.1002/advs.202415961. Epub 2025 Feb 18.
Functional complete revascularization (CR) after percutaneous coronary intervention (PCI) as determined by classic residual functional SYNTAX score (c-rFSS) has been associated with improved prognosis. In this study, the c-rFSS algorithm is optimized for a novel modified rFSS (m-rFSS) and prognostic implications of this novel scoring is determined. The m-rFSS algorithm is updated for 2 clinical scenarios, i.e., 1) lesions with suboptimal functional results, and 2) angiographic diameter stenosis <50% but functionally significant stenoses, which are not scored by c-rFSS. The major outcome is a 2-year major adverse cardiac event (MACE). A total of 1,555 patients analyzable for both c-rFSS and m-rFSS are included. After calculating m-rFSS, 12.0% (187/1,555) of patients with c-rFSS-based functional CR (c-rFSS = 0) are reclassified as having m-rFSS-based incomplete revascularization (IR, m-rFSS>0); thus, 377 (21.7%) patients have c-rFSS-based functional IR whereas 524 (33.7%) has m-rFSS-based IR. Patients with m-rFSS-based functional IR (m-rFSS>0) show a significantly higher risk for major MACE outcome (20.8% vs 5.9%; adjusted hazard ratio 3.32, 95% confidence interval: 2.34-4.71) than patients with functional CR (m-rFSS = 0). The m-rFSS is more predictive of 2-year MACE than c-rFSS (difference in C-index 0.07, p < 0.001). In this study, we optimized the classic scoring algorithm to develop a novel scoring system (m-rFSS), and revascularization completeness determined by m-rFSS is markedly associated with a 2-year prognosis.
经皮冠状动脉介入治疗（PCI）后，根据经典残余功能SYNTAX评分（c-rFSS）确定的功能性完全血运重建（CR）与预后改善相关。在本研究中，对c-rFSS算法进行优化以获得一种新的改良rFSS（m-rFSS），并确定这种新评分的预后意义。m-rFSS算法针对2种临床情况进行了更新，即1）功能结果欠佳的病变，以及2）血管造影直径狭窄<50%但功能上有意义的狭窄，而c-rFSS对这些情况未进行评分。主要结局为2年主要不良心脏事件（MACE）。共纳入1555例可同时分析c-rFSS和m-rFSS的患者。计算m-rFSS后，基于c-rFSS的功能性CR（c-rFSS = 0）患者中有12.0%（187/1555）被重新分类为基于m-rFSS的不完全血运重建（IR，m-rFSS>0）；因此，377例（21.7%）患者为基于c-rFSS的功能性IR，而524例（33.7%）患者为基于m-rFSS的IR。基于m-rFSS的功能性IR（m-rFSS>0）患者发生主要MACE结局的风险显著高于功能性CR（m-rFSS = 0）的患者（20.8%对5.9%；调整后风险比3.32，95%置信区间：2.34 - 4.71）。m-rFSS比c-rFSS更能预测2年MACE（C指数差异为0.07，p < 0.001）。在本研究中，我们优化了经典评分算法以开发一种新的评分系统（m-rFSS），并且由m-rFSS确定的血运重建完整性与2年预后显著相关。
