Abdeldayem Tarek, Memon Saif, Omari Muntaser, Farag Mohamed, Al-Atta Ayman, Ibrahem Abdalazeem, Salim Tarik, Bawamia Bilal, Egred Mohaned, Alkhalil Mohammad
Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne NE1 7RU, UK.
Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK.
J Clin Med. 2025 May 14;14(10):3433. doi: 10.3390/jcm14103433.
Diabetic patients tend to have complex coronary artery disease (CAD). Understanding their procedural risk may help to guide treatment strategies. SYNTAX and the British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS) have been used to define complex CAD, but their use has not been compared in diabetic patients. This is a retrospective analysis of prospectively collected data of consecutive patients who underwent complex percutaneous coronary intervention (PCI) and were deemed unsuitable for surgical revascularization. Both SYNTAX and BCIS-JS were calculated by experienced operators who were blinded to patient's outcome. The primary endpoint was all-cause mortality at 12 months. Of 452 patients included in the study, diabetes was present in 35% patients. There was a modest relationship between BCIS-JS and SYNTAX score (Spearman r = 0.44, < 0.001) and this relationship was even weaker in patients with diabetes (Spearman r = 0.32, < 0.001). The primary endpoint was comparable in the non-diabetic group, irrespective of the score system (SYNTAX or BCIS-JS) used to define complex CAD. In contrast, there was a differential prognostic outcome in the diabetic group, whereby the primary endpoint was more frequently reported in diabetic patients with high versus low SYNTAX scores [HR 4.96, 95% CI (1.44-17.03), = 0.011] but not when BCIS-JS was used. There was a modest relationship between BCIS-JS and SYNTAX score. Unlike BCIS-JS, the SYNTAX score identified those who are at increased risk of death among diabetic patients. Both scoring systems did not effectively differentiate mortality risk in non-diabetic patients. Future research is needed to confirm this study's findings.
糖尿病患者往往患有复杂的冠状动脉疾病（CAD）。了解他们的手术风险可能有助于指导治疗策略。SYNTAX评分和英国心血管介入学会风险评分（BCIS-JS）已被用于定义复杂CAD，但尚未在糖尿病患者中对它们的应用进行比较。这是一项对连续接受复杂经皮冠状动脉介入治疗（PCI）且被认为不适合外科血运重建的患者的前瞻性收集数据的回顾性分析。SYNTAX评分和BCIS-JS均由对患者结局不知情的经验丰富的操作人员计算得出。主要终点是12个月时的全因死亡率。在纳入研究的452例患者中，35%的患者患有糖尿病。BCIS-JS与SYNTAX评分之间存在适度相关性（Spearman r = 0.44，P < 0.001），而在糖尿病患者中这种相关性更弱（Spearman r = 0.32，P < 0.001）。在非糖尿病组中，无论使用哪种评分系统（SYNTAX或BCIS-JS）来定义复杂CAD，主要终点都是可比的。相比之下，糖尿病组存在不同的预后结果，即SYNTAX评分高的糖尿病患者比评分低的患者更频繁地出现主要终点事件[风险比（HR）4.96，95%置信区间（CI）（1.44 - 17.03），P = 0.011]，但使用BCIS-JS时并非如此。BCIS-JS与SYNTAX评分之间存在适度相关性。与BCIS-JS不同，SYNTAX评分识别出了糖尿病患者中死亡风险增加的人群。两种评分系统均未有效区分非糖尿病患者的死亡风险。未来需要进一步研究来证实本研究的结果。
