Angleitner Philipp, Abfalterer Hannes, Kaider Alexandra, Manville Emely, Bichler Martin, Graber Michael, Pölzl Leo, Zimpfer Daniel, Sandner Sigrid, Bonaros Nikolaos
Department of Cardiac Surgery, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria.
Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
J Cardiothorac Surg. 2025 Aug 7;20(1):324. doi: 10.1186/s13019-025-03572-x.
Our aim was to evaluate SYNTAX Score II for its ability to predict mortality in all-comers undergoing isolated coronary artery bypass grafting.
External validation of SYNTAX Score II was performed in a retrospective analysis of 2 tertiary care centers. Mortality at 4 years after surgery was defined as the primary outcome variable. External validation included assessment of calibration (calibration-in-the-large, observed-expected ratio, calibration slope) and discrimination (concordance statistic, Receiver Operating Characteristic curve). Additionally, SYNTAX Score II's performance was compared with the performance of EuroSCORE II, the logistic EuroSCORE, and ACEF Score.
The study cohort included 1454 patients (Medical University of Vienna, n = 782; Medical University of Innsbruck, n = 672). Kaplan-Meier survival curves showed that tertiles of SYNTAX Score II were significantly associated with mortality (log-rank test, p < 0.001). In a stratified multivariable Cox proportional-hazards regression model, the following score components were independently associated with mortality: age (hazard ratio 1.03, 95% confidence interval 1.00 to 1.06), creatinine clearance (hazard ratio 0.98, 95% confidence interval 0.97 to 0.99), left-ventricular ejection fraction (hazard ratio 0.97, 95% confidence interval 0.95 to 0.98), and chronic obstructive pulmonary disease (hazard ratio 2.02, 95% confidence interval 1.34 to 3.05). The anatomical SYNTAX Score was not independently associated with mortality (hazard ratio 1.00, 95% confidence interval 0.98 to 1.02). Assessment of SYNTAX Score II calibration revealed an observed-expected ratio of 0.61 and a calibration slope of 0.62 (p < 0.001 for comparison with slope = 1.0), indicating general overestimation of 4-year mortality. The c-statistic amounted to 0.73. Performance of SYNTAX Score II was comparable with the performance of EuroSCORE II (c-statistic 0.73), the logistic EuroSCORE (c-statistic 0.74) and ACEF Score (c-statistic 0.72).
Our analysis shows that SYNTAX Score II has acceptable discriminative strength with respect to 4-year mortality in all-comers undergoing isolated coronary artery bypass grafting. Notably, mortality is over-estimated in patients with higher SYNTAX Score II values. SYNTAX Score II, EuroSCORE II, the logistic EuroSCORE, and ACEF Score offer comparable predictive value towards 4-year mortality.
我们的目的是评估SYNTAX评分II预测接受单纯冠状动脉搭桥术的所有患者死亡率的能力。
在对2个三级医疗中心进行的回顾性分析中对SYNTAX评分II进行外部验证。将术后4年的死亡率定义为主要结局变量。外部验证包括校准评估（大样本校准、观察-期望比、校准斜率）和区分度评估（一致性统计量、受试者工作特征曲线）。此外，将SYNTAX评分II的性能与欧洲心脏手术风险评估系统II（EuroSCORE II）、逻辑欧洲心脏手术风险评估系统以及ACEF评分的性能进行比较。
研究队列包括1454例患者（维也纳医科大学，n = 782；因斯布鲁克医科大学，n = 672）。Kaplan-Meier生存曲线显示，SYNTAX评分II的三分位数与死亡率显著相关（对数秩检验，p < 0.001）。在分层多变量Cox比例风险回归模型中，以下评分成分与死亡率独立相关：年龄（风险比1.03，95%置信区间1.00至1.06）、肌酐清除率（风险比0.98，95%置信区间0.97至0.99）、左心室射血分数（风险比0.97，95%置信区间0.95至0.98）以及慢性阻塞性肺疾病（风险比2.02，95%置信区间1.34至3.05）。解剖学SYNTAX评分与死亡率无独立相关性（风险比1.00，95%置信区间0.98至1.02）。SYNTAX评分II校准评估显示观察-期望比为0.61，校准斜率为0.62（与斜率 = 1.0比较，p < 0.001），表明对4年死亡率总体高估。c统计量为0.73。SYNTAX评分II的性能与EuroSCORE II（c统计量0.73）、逻辑欧洲心脏手术风险评估系统（c统计量0.74）以及ACEF评分（c统计量0.72）的性能相当。
我们的分析表明，SYNTAX评分II对于接受单纯冠状动脉搭桥术的所有患者4年死亡率具有可接受的区分强度。值得注意的是，SYNTAX评分II值较高的患者死亡率被高估。SYNTAX评分II、EuroSCORE II、逻辑欧洲心脏手术风险评估系统以及ACEF评分对4年死亡率具有相当的预测价值。
