SYNTAX评分和临床SYNTAX评分对冠心病患者接受经皮冠状动脉介入治疗后临床事件风险的预测价值

目的 评估SYNTAX评分(SXscore)和临床SYNTAX评分(CSS)对接受经皮冠状动脉介入治疗(PCI)术后15个月主要终点事件的预测价值.方法 共纳入547名接受择期PCI或直接PCI患者,记录病变SXscore和CSS评分,随访PCI术后终点事件发生情况,评估评分与事件的关系.结果 随访15个月,高、中、低SXscore三组主要不良心脑血管事件(MACCE)发生率分别为13.5%、6.8%及0.0%(P＜0.0001).控制混杂因素后,多因素回归分析显示,SXscore(RR=1.101,95%CI 1.070～1.134)及CSS(RR=1.017,95%CI 1.009～1.022)均是MACCE事件的独立预测因子(均为P＜0.0001).结论 SXscore评分和CSS评分是冠心病患者接受PCI术后MACCE事件的独立预测因子.     

Prognostic significance of the SYNTAX score and SYNTAX score II in patients with myocardial infarction treated with percutaneous coronary intervention

Objectives

We aimed to evaluate the prognostic significance of the SYNTAX score (SS) and SYNTAX score II (SS-II) in a contemporary real-world cohort of myocardial infarction (MI) patients treated with percutaneous coronary intervention (PCI).

Background

The role of SS and SS-II in the prognostic stratification of patients presenting with MI and undergoing PCI has been poorly investigated.

Methods

This study included MI patients treated with PCI from January 2015 to April 2020 at the University Hospital of Salerno. Patients were divided into tertiles according to the baseline SS and SS-II values. The primary outcome measure was all-cause mortality at long-term follow-up; secondary outcome measures were cardiovascular (CV) death and MI.

Results

Overall, 915 patients were included in this study. Mean SS and SS-II were 16.1 ± 10.0 and 31.6 ± 11.5, respectively. At propensity weighting adjusted Cox regression analysis, both SS (hazard ratio [HR]: 1.02; 95% confidence interval [CI]: 1.02−1.06; p = 0.017) and SS-II (HR: 1.08; 95% CI: 1.07−1.10; p < 0.001) were significantly associated with the risk of all-cause mortality at long-term follow-up; both SS (HR 1.04; CI 1.01−1.06; p < 0.001) and SS-II (HR 1.08; CI 1.06−1.10; p < 0.001) were significantly associated with the risk of CV death, but only SS-II showed a significant association with the risk of recurrent MI (HR 1.03; CI 1.01−1.05; p < 0.001). At 5 years, SS-II showed a significantly higher discriminative ability for all-cause mortality than SS (area under the curve: 0.82 vs. 0.64; p < 0.001). SS-II was able to reclassify the risk of long-term mortality beyond the SS (net reclassification index 0.88; 95% CI: 0.38−1.54; p = 0.033).

Conclusions

In a real-world cohort of MI patients treated with PCI, SS-II was a stronger prognostic predictor of long-term mortality than SS.     

SYNTAX积分对冠心病经皮冠状动脉介入治疗效果的预测

目的 研究SYNTAX积分对复杂冠心病患者经皮冠状动脉(冠脉)介入治疗术(PCI)效果预测作用.方法 回顾性分析PCI置入雷帕霉素药物洗脱支架左主干/3支病变的冠心病患者共190例,计算SYNTAX积分及临床SYNTAX积分,随访其主要不良心脑血管事件(MACCE),包括死亡、非致命性心肌梗死、再次血运重建、脑血管事件发生率.分别评价SYNTAX积分及临床SYNTAX 积分对PCI效果的预测作用.结果 SYNTAX积分低、中及高分组的MACCE率分别为9.1％、16.2％及30.9％.临床SYNTAX评分低、中及高分组的MACCE率分别为14.9％、9.8％及30.6％,单因素及多因素分析结果均显示SYNTAX积分及临床SYNTAX积分是MACCE的独立预测因子.ROC 曲线分析结果SYNTAX积分AUC (0.667)大于临床SYNTAX积分AUC (0.636).结论 SYNTAX积分及临床SYNTAX积分对冠脉左主干/3支病变患者行PCI治疗后是否发生MACCE均有预测作用,在这一组人群中临床SYNTAX积分不优于SYNTAX积分.     

The SYNTAX score revisited: A reassessment of the SYNTAX score reproducibility

Objectives : To reassess the reproducibility of the SYNTAX score. Background : The SYNTAX score appears to have an important role to play in the evaluation of patients with complex coronary artery disease undergoing revascularisation. However, the calculation of the SYNTAX score relies on the subjective assessment of lesions using coronary angiography, and therefore is subject to intra‐and inter‐observer variability. Methods : The SYNTAX score was calculated in 100 patients randomly selected from the SYNTAX trial, on two occasions 8 weeks apart, by a team made up of three interventional cardiologists. The weighted kappa values were compared with values obtained 1 year previously, when core lab analysts assessed the intra‐observer reproducibility amongst the same patient cohort. Results : The mean ± standard deviation difference in SYNTAX score was 2.1 ± 7.6. The respective weighted kappa values for the number of lesions, bifurcation lesions, ostial lesions, and total occlusions were 0.62, 0.36, 0.66, and 0.91 compared with 0.59, 0.41, 0.63, and 0.82 in the previous core lab assessment. The weighted kappa for the intra‐observer reproducibility of the SYNTAX score grouped into deciles was 0.54, and according to the terciles ≤22, >22–≤32, >32 was 0.51 both indicating a moderate level of agreement beyond the level of chance. In the previous assessment, the comparative kappa values were 0.45 and 0.53. Conclusions : The SYNTAX score has moderate intra‐observer reproducibility when assessed by a team of three interventional cardiologists, which is consistent with a prior evaluation performed by core lab analysts. The scoring of bifurcation lesions remains the main source of inconsistency. © 2009 Wiley‐Liss, Inc.     

Validating the EXCEL hypothesis: A propensity score matched 3‐year comparison of percutaneous coronary intervention versus coronary artery bypass graft in left main patients with SYNTAX score ≤32

Objectives : The aim of this study is to verify the study hypothesis of the EXCEL trial by comparing percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) in an EXCEL‐like population of patients. Background : The upcoming EXCEL trial will test the hypothesis that left main patients with SYNTAX score ≤32 experience similar rates of 3‐year death, myocardial infarction (MI), or cerebrovascular accidents (CVA) following revascularization by PCI or CABG. Methods : We compared the 3‐year rates of death/MI/CVA and death/MI/CVA/target vessel revascularization (MACCE) in 556 patients with left main disease and SYNTAX score ≤32 undergoing PCI (n = 285) or CABG (n = 271). To account for confounders, outcome parameters underwent extensive statistical adjustment. Results : The unadjusted incidence of death/MI/CVA was similar between PCI and CABG (12.7% vs. 8.4%, P = 0.892), while MACCE were higher in the PCI group compared to the CABG group (27.0% vs. 11.8%, P < 0.001). After propensity score matching, PCI was not associated with a significant increase in the rate of death/MI/CVA (11.8% vs. 10.7%, P = 0.948), while MACCE were more frequently noted among patients treated with PCI (28.8% vs. 14.1%, P = 0.002). Adjustment by means of SYNTAX score and EUROSCORE, covariates with and without propensity score, and propensity score alone did not change significantly these findings. Conclusions : In an EXCEL‐like cohort of patients with left main disease, there seems to be a clinical equipoise between PCI and CABG in terms of death/MI/CVA. However, even in patients with SYNTAX score ≤32, CABG is superior to PCI when target vessel revascularization is included in the combined endpoint. © 2011 Wiley‐Liss, Inc.     

SYNTAX积分和Gensini评分对急性ST段抬高心肌梗死患者远期心血管事件的预测价值

目的探讨SYNTAX积分和Gensini评分对急性ST段抬高心肌梗死（STEMI）患者远期预后的预测价值。方法采用回顾性分析,连续入选2008年1月1日至2009年12月31日因STEMI收入北京大学第三医院心脏重症监护室,经皮冠状动脉介入治疗（PCI）并存活出院的患者共178例,计算SYNTAX积分和Gensini评分,按三分类法将患者分为3组：SYNTAX积分低分组SSlow〈10分（49例）、中分组10分≤SSmid〈18分（69例）、高分组SShigh≥18分（60例）;Gensini评分低分组GSlow〈41分（59例）、中分组41分≤GSmid〈64分（65例）、高分组GShigh≥64分（54例）。随访其主要不良心血管事件（major adverse cardiac events,MACE）,包括全因死亡、非致命性心肌梗死、再次血运重建、再次因心脏病住院的发生率,平均随访（4.7±0.5）年。结果 SYNTAX积分低分、中分及高分组的MACE发生率分别是18.4%、21.7%和45.0%,组间比较差异有显著统计学意义（P=0.004）。Gensini评分低分、中分及高分组的MACE发生率分别是20.3%、33.8%和33.3%,组间比较差异无统计学意义（P=0.186）。Cox多因素分析显示,SYNTAX积分是术后5年发生MACE的独立预测因子（P=0.037）,以高分组为参照,中分组发生MACE的风险显著降低（HR 0.42,95%CI 0.21~0.84,P=0.015）;而Gensini评分对远期预后无预测价值。结论 SYNTAX积分是STEMI患者远期发生MACE的独立预测因子,而Gensini评分对STEMI患者远期MACE发生率无预测价值。     

三种评分对经皮冠状动脉介入治疗急性非ST段抬高心肌梗死患者的预测价值比较

目的探讨ACUITY-PCI评分与GRACE评分和SYNTAX评分对接受PCI的急性非ST段抬高心肌梗死(NSTEMI)患者预后的预测价值。方法收集252例NSTEMI患者临床资料。对每例患者进行ACUITY-PCI、GRACE和SYNTAX评分,随访1年,随访终点为主要不良心血管事件(全因死亡,非致命性心肌梗死、再次血运重建)。将3种评分方法对终点事件预测价值进行比较和分析。结果 GRACE评分、SYNTAX评分及ACUITY-PCI评分预测NSTEMI患者1年主要不良心血管事件的ROC曲线下面积呈依次递增趋势,其准确性分别为0.627(95%CI:0.535⁰.720),0.671(95%CI:0.5890.720),0.671(95%CI:0.589⁰.753),0.754(95%CI:0.6890.753),0.754(95%CI:0.689⁰.802)。3种评分方法均具有良好的拟合优度,其中ACUITY-PCI评分同时具备较好的准确性和拟合优度。结论ACUITY-PCI评分可预测接受PCI的NSTEMI患者预后,其同时具备较好的准确性和拟合优度。     

SYNTAX积分对经皮冠状动脉介入治疗的临床疗效与预测作用研究

目的:研究SYNTAX积分、临床SYNTAX积分及Global Risk Classification(GRC)对左主干/3支病变的冠心病患者,经皮冠状动脉介入治疗术后临床的预测作用,并评价三种积分系统的预测价值。方法:回顾性分析自2007年1月31日至2008年12月31日,北京安贞医院心内科经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)置入Cypher select药物洗脱支架的左主干/3支病变的冠心病患者共190例。根据冠状动脉造影结果计算三种积分系统,并根据3分位数值分别分为低分、中分及高分组。通过门诊或电话随访PCI术后患者的主要不良心脑血管事件(major adverse cardiac and cerebrovascular events,MACCE),包括死亡、非致命性心肌梗死、再次血运重建、脑血管事件发生率。分别评价三种积分系统对患者术后临床预后的预测作用,评价三者的预测能力。结果:190例患者中,失访10例,失访率5.3%,随访中位数为29.4个月,29例观察到MACCE,MACCE发生率18.5%。SYNTAX积分低分(≤20.5)、中分(21.0~31.0)及高分组(≥31.5)的主要MACCE发生率分别为9.1%、16.2%及30.9%。临床SYNTAX评分低分(≤19.5)、中分(19.6~29.1)及高分组(≥29.2)的主要MACCE率分别为14.9%、9.8%及30.6%。GRC低、中、高分组的MACCE发生率分别为17.8%、14.2%及46.1%,单因素及多因素分析结果均显示三种积分系统是MACCE的独立预测因子。ROC曲线分析结果 SYNTAX积分AUC=0.667(95%CI=0.564~0.770,P=0.004),临床SYNTAX积分AUC=0.636(95%CI=0.519~0.753,P=0.020),GRC预测PCI术后MACCE的能力(AUROC=0.617,95%CI=0.512~0.736,P=0.046),三者都显示对MACCE有预测价值。结论:三种积分系统对冠状动脉左主干/3支病变患者行PCI治疗后的MACCE均有预测作用,可作为MACCE的独立预测因子。     

残余SYNTAX评分评估老年ST段抬高型心肌梗死PCI术后不良预后的临床价值

目的比较SYNTAX评分和残余SYNTAX(rSS)评分评估老年ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入治疗(PCI)术后不良预后的临床价值。方法收集2017年3月—2019年1月在洛阳市中医院确诊的STEMI并行PCI治疗的病人210例,根据是否发生主要不良心脑血管事件(MACCE)分为MACCE组和非MACCE组。比较两组临床资料,采用Logistic多因素回归分析影响MACCE发生的独立因素,Cox回归模型比较SYNTAX评分和rSS评分评估老年STEMI行PCI治疗术后不良预后的临床价值。结果MACCE组与非MACCE组相比,病人年龄、SYNTAX评分和rSS评分较高,高血压、脑梗死/短暂性脑缺血发作(TIA)、冠状动脉三支病变病人所占比例较高(P<0.05)。经Logistic多因素回归分析显示年龄、SYNTAX评分和rSS评分为STEMI病人PCI术后发生MACCE的独立影响因素。SYNTAX评分预测STEMI病人PCI术后发生MACCE灵敏度和特异度分别为72.3%、65.4%,曲线下面积为0.702,截断值32分;rSS评分预测STEMI病人PCI术后发生MACCE灵敏度和特异度分别为82.3%、74.6%,曲线下面积为0.824,截断值5分。rSS>5分组MACCE的发生率为37.2%、脑卒中发生率为14.0%和再次血运重建率为11.6%,均高于rSS≤5分组,全因死亡率和再发心肌梗死率组间比较差异无统计学意义。结论rSS>5分是老年STEMI行PCI治疗术后不良预后的独立危险因素,临床预测价值大于SYNTAX评分。     

Prognostic Value of SYNTAX Score in Patients With Infarct-Related Cardiogenic Shock: Insights From the CULPRIT-SHOCK Trial

ObjectivesThis study sought to evaluate the prognostic value of the SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) scores in patients undergoing percutaneous coronary intervention (PCI) for multivessel coronary disease with infarct-related cardiogenic shock (CS).BackgroundThe prognostic value of the SYNTAX score in this high-risk setting remains unclear.MethodsThe CULPRIT-SHOCK (Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock) trial was an international, open-label trial, where patients presenting with infarct-related CS and multivessel disease were randomized to a culprit-lesion-only or an immediate multivessel PCI strategy. Baseline SYNTAX score was assessed by a central core laboratory and categorized as low SYNTAX score (SS ≤22), intermediate SYNTAX score (22<SS≤32) and high SYNTAX score (SS>32). Adjudicated endpoints of interest were the 30-day risk of death or renal replacement therapy (RRT) and 1-year death. Associations between baseline SYNTAX score and outcomes were assessed using multivariate logistic regression.ResultsPre-PCI SYNTAX score was available in 624 patients, of whom 263 (42.1%), 207 (33.2%) and 154 (24.7%) presented with low, intermediate and high SYNTAX score, respectively. A stepwise increase in the incidence of adverse events was observed from low to intermediate and high SYNTAX score for the 30-day risk of death or RRT and the 1-year risk of death (p < 0.001, for all). After multiple adjustments, intermediate and high SYNTAX score remained strongly associated with 30-day risk of death or renal replacement therapy and 1-year risk of all-cause death. There was no significant interaction between SYNTAX score and the coronary revascularization strategy for any outcomes.ConclusionsIn patients presenting with multivessel disease and infarct-related CS, the SYNTAX score was strongly associated with 30-day death or RRT and 1-year mortality.     

Comparison of multiple risk scores in assessing medium-to long-term clinical outcomes in unstable angina / non-ST-elevation myocardial infarction patients undergoing multi vessel percutaneous coronary intervention: An observational,registry-based study in India

ObjectivePost-revascularization mortality in multivessel coronary artery disease (MVCAD) has been explored via several risk scores. Here, we assessed and compared various risk scores in predicting medium to long-term clinical outcomes in unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) patients with MVCAD undergoing percutaneous coronary intervention (PCI).MethodsWe analyzed a cohort of a tertiary care center registry enrolling patients in South India, Kerala, with MVCAD (N = 200) who had undergone PCI between 2010 and 2018. The outcomes evaluated were all-cause mortality and major adverse cardiac events (MACE). The risk scores assessed included SYNTAX score (SS), residual SYNTAX score (rSS), SYNTAX revascularization index (SRI), age, creatinine, and ejection fraction (ACEF) score, clinical SYNTAX score (cSS), and SYNTAX score II (SSII).ResultsOf the analyzed risk scores, SSII had the best predictive capability with the area under the curve (AUC) of 0.79 in c-statistics, followed by ACEF score and cSS with AUCs of 0.74 and 0.65, respectively for all-cause mortality (p < 0.01). Kaplan–Meier survival curves and multivariate analysis by Cox regression showed SSII with cut-offs of >35.15 and > 29.55 to be the only score associated with higher mortality and MACE, respectively.ConclusionsIn UA/NSTEMI patients with relatively less complex MVCAD treated by PCI, the SSII, ACEF and cSS risk scores could predict the outcomes better. The SSII showed the best predictive performance for all-cause mortality and MACE. Scores based on baseline and residual atherosclerotic burden (SS, rSS, and SRI) performed poorly in predicting the mortality and MACE.     

稳定型冠心病患者血清低密度脂蛋白胆固醇和载脂蛋白B浓度与SYNTAX评分的关系

目的探讨稳定型冠状动脉粥样硬化性心脏病(stable coronary artery disease,SCAD)患者血清低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)和载脂蛋白B浓度与SYNTAX评分的关系。方法回顾性选择2016年1月至2017年12月在宝鸡市中心医院接受冠状动脉造影检查确诊的SCAD患者150例作为研究对象,根据SYNTAX评分结果将患者分为0~22分组(低分组,n=80)、23~32分组(中分组,n=40)和33分以上组(高分组,n=30)。SYNTAX评分与不同临床特征间的相关性采用Spearman相关性分析和多元线性回归分析。结果3组患者血小板分布宽度(platelet distribution width,PDW)、红细胞分布宽度(red cell distribution width,RDW)、纤维蛋白原、总胆固醇、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)、LDL-C、脂蛋白a、载脂蛋白A1、载脂蛋白B、SYNTAX评分比较,差异有统计学意义(P<0.05)。Spearman相关性分析结果显示,SYNTAX评分与HDL-C、载脂蛋白A1呈负相关(P<0.05),与纤维蛋白原、总胆固醇、LDL-C、PDW、RDW、脂蛋白a、载脂蛋白B呈正相关(P<0.05)。多元线性回归分析结果显示,HDL-C、LDL-C、纤维蛋白原、载脂蛋白B均是影响冠状动脉病变的危险因素(P<0.05)。结论随着血清LDL-C、载脂蛋白B浓度的升高,SCAD患者SYNTAX评分升高,冠状动脉病变严重程度加重。血清LDL-C、载脂蛋白B浓度可作为判断SCAD患者冠状动脉病变严重程度的参考指标。     

Prognostic value of the age,creatinine, and ejection fraction score for non‐infarct‐related chronic total occlusion revascularization after primary percutaneous intervention in acute ST‐elevation myocardial infarction patients: A retrospective study

Objective

It is not known if ACEF scores could evaluate the prognosis of recanalization of non‐infarct‐related coronary arteries (non‐IRA) with chronic total occlusions (CTO) in patients who successfully underwent primary PCI. The objective of the current study was to assess the prognostic value of ACEF scores in acute ST‐segment elevation myocardial infarction (STEMI) patients with non‐IRA CTO after successful primary PCI.

Methods

There were 2952 STEMI patients who underwent successful primary PCI from January 2006 to December 2014 in our hospital, among them 377 patients had a non‐IRA CTO lesion. The patients were divided into successful CTO‐PCI group (n = 221) and failed/non‐attempted CTO‐PCI group (n = 156). Patients were stratified based on the ACEF tertiles. Primary end points measured in the current study were major adverse cardiac events (MACE) defined as the composite of all‐cause death, nonfatal myocardial infarction, ischemia‐driven coronary revascularization and hospitalization for heart failure at 1 year.

Results

The incidence of MACE, all‐cause death and cardiac death were higher in the failed/non‐attempted CTO‐PCI group (P < 0.001). In the successful CTO‐PCI group, the cumulative 1‐year incidences of MACE and all‐cause death were decreased compared to those in the failed/non‐attempted CTO‐PCI group (log‐rank P < 0.001). The risk for MACE was reduced in the successful CTO‐PCI group compared to the failed/non‐attempted CTO‐PCI group in patients with low and intermediate ACEF scores (log‐rank P = 0.02).

Conclusions

Successfully staged CTO‐PCI could gain advantageous clinical outcomes in those patients with low or intermediate ACEF scores.     

The MI SYNTAX score for risk stratification in patients undergoing primary percutaneous coronary intervention for treatment of acute myocardial infarction: A substudy of the COMFORTABLE AMI trial

Background

To investigate the performance of the MI Sxscore in a multicentre randomised trial of patients undergoing primary percutaneous coronary intervention (PPCI).

Methods and results

The MI Sxscore was prospectively determined among 1132 STEMI patients enrolled into the COMFORTABLE AMI trial, which randomised patients to treatment with bare-metal (BMS) or biolimus-eluting (BES) stents. Patient- (death, myocardial infarction, any revascularisation) and device-oriented (cardiac death, target-vessel MI, target lesion revascularisation) major adverse cardiac events (MACEs) were compared across MI Sxscore tertiles and according to stent type.The median MI SXscore was 14 (IQR: 9–21). Patients were divided into tertiles of Sxscore_low (≤ 10), Sxscore_intermediate (11–18) and Sxscore_high (≥ 19). At 1 year, patient-oriented MACE occurred in 15% of the Sxscore_high, 9% of the Sxscore_intermediate and 5% of the Sxscore_low tertiles (p < 0.001), whereas device-oriented MACE occurred in 8% of the Sxscore_high, 6% of the Sxscore_intermediate and 4% of the Sxscore_low tertiles (p = 0.03). Addition of the MI Sxscore to the TIMI risk score improved prediction of patient- (c-statistic value increase from 0.63 to 0.69) and device-oriented MACEs (c-statistic value increase from 0.65 to 0.70). Differences in the risk for device-oriented MACE between BMS and BES were evident among Sxscore_high (13% vs. 4% HR 0.33 (0.15–0.74), p = 0.007 rather than those in Sxscore_low: 4% vs. 3% HR 0.68 (0.24–1.97), p = 0.48) tertiles.

Conclusions

The MI Sxscore allows risk stratification of patient- and device-oriented MACEs among patients undergoing PPCI. The addition of the MI Sxscore to the TIMI risk score is of incremental prognostic value among patients undergoing PPCI for treatment of STEMI.     

胆固醇代谢标志物与冠状动脉SYNTAX评分的相关性研究

目的:探讨冠心病患者胆固醇代谢标志物水平与反映冠状动脉病变严重程度的SYNTAX评分的关系。方法:回顾分析在我院接受冠状动脉造影检查的冠心病患者共103例,根据冠状动脉造影结果计算SYNTAX评分,根据评分数值分为低、中、高危组,检测所有患者接受调脂治疗前胆固醇代谢标志物的水平,分析胆固醇代谢标志物与SYNTAX评分之间的关系。结果:SYNTAX评分中危组较低危组患者的菜油固醇、谷固醇水平均显著增高(P<0.05),提示随着胆固醇吸收标志物水平的升高,冠状动脉病变严重程度加重。相关性分析显示:菜油固醇、谷固醇与SYNTAX评分呈正相关。多元线性回归分析结果显示:谷固醇(B=0.233,P=0.043)与SYNTAX评分呈正相关。结论:胆固醇吸收标志物与SYNTAX评分正相关,可作为判断冠状动脉病变严重程度的参考指标之一。     

Residual SYNTAX score can predict short- and long-term outcomes in patients with STEMI

ObjectivesThe prognostic value of residual SYNTAX score (rSS) has been observed in different patient groups. However, its prognostic value has not been compared in patients with ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).MethodsA total of 208 patients meeting the eligibility criteria were included in the study. Complete revascularisation (CR) was defined as rSS = 0 and incomplete revascularisation (IR) was defined as rSS ≥ 1.ResultsAmong the sample, 78 patients (33.3%) were included in the CR group and 130 patients (67.7%) in the IR group. One patient (1.3%) in the CR group and 8 patients (6.2%) in the IR group died by day 30 (P < 0.01). The incidence of stent thrombosis, recurrent myocardial infarction (MI) and target lesion revascularisation (TLR) was similar between the two groups. During follow-up (mean 28.8 ± 7.1 months), 2 patients (2.6%) from the CR group and 10 (7.7%) patients from the IR group died (P > 0.05). The incidence of recurrent MI (18.5% vs. 7.7%; P < 0.01) and major adverse cardiovascular events (MACE) (24.6% vs. 7.7%; P < 0.01) were significantly higher in the IR group.ConclusionrSS, which is an indirect marker of incomplete revascularisation, was independently correlated with recurrent MI and MACE after STEMI.     

Long-term outcomes following left main bifurcation stenting in Indian population—Analysis based on SYNTAX I and II scores

BackgroundSyntax 1 and recently Syntax 2 (SS2) scores are validated risk prediction models in coronary disease.ObjectivesTo find out the long term outcomes following stenting for unprotected left main bifurcation disease (LMD) and to validate and compare the performance of the SYNTAX scores 1 and 2 (SS1 and SS2 PCI) for predicting major adverse cardiac events (MACE) in Indian population.MethodsSingle-center, retrospective, observational study involving patients who underwent percutaneous coronary intervention (PCI) with at least one stent implanted for the LMD. Discrimination and calibration models were assessed by ROC curve and the Hosmer-Lemeshow test.ResultsData of 103 patients were analyzed. The mean SS1 and SS2 scores were 27.9 and 30.7 and MACE was 16.5% at 4 years. The target lesion revascularization (TLR) rate at 4 years was 11(10.7%). There were 4 deaths (3.8%). The mean left ventricular ejection fraction (LVEF) was the only variable in SS2, which predicted cardiac events. ROC curve analysis showed both models to be accurate in predicting TLR and mortality following LM PCI. SS2 score showed a better risk prediction than SSI with AUC for TLR (SSI 0.560 and SS2PCI 0.625) and AUC for mortality (SS1 0.674 and SS2PCI 0.833). Hosmer-Lemeshow test validated the accuracy of both the risk models in predicting the events.ConclusionsBoth risk models were applicable for Indian patients. The SS2 score was a better predictor for mortality and TLR. In the SS2 score, the LVEF was the most useful predictor of events after LM PCI.     

Risk Stratification Following Complex PCI: Clinical Versus Anatomical Risk Stratification Including “Post PCI Residual SYNTAX‐Score” as Quantification of Incomplete Revascularization

Background

EuroSCORE and completeness of revascularization predicts long‐term survival after multivessel PCI (MV‐PCI). The SYNTAX‐Score has also been proposed to predict clinical outcome. The prognostic impact of these scores to predict long‐term survival after PCI has not yet been compared.

Methods and Results

Long‐term survival was assessed in 740 patients undergoing MV‐PCI. We calculated EuroSCORE, SYNTAX‐Score, STS‐Score, the clinical SYNTAX‐Score (CSS), and the “post‐PCI residual SYNTAX‐Score.” Mean follow‐up time was 4.5 ± 2.5 years. 341 patients (46%) were treated for ACS (STEMI N = 191; NSTEMI N = 150). 113 patients (15%) underwent PCI of left main coronary artery. The EuroSCORE was significantly lower for stable patients compared to patients with ACS (stable 4.1 ± 4.5, NSTEMI 13.9 ± 13.3, STEMI 18.1 ± 18.7, p < 0.001). The differences in the SYNTAX‐Score were less obvious but even significant (stable 14.9 ± 8.6, NSTEMI 17.8 ± 9.9, STEMI 18.3 ± 9.0; p < 0.001). Patients in the highest tertiles of each risk score experienced a dramatically elevated mortality rate compared to the extremely low mortality rate in the lower tertiles (p log‐rank <0.001). This comparison remained significant for the EuroSCORE and STS‐Score but not for the SYNTAX‐Score, when analysis was restricted to stable patients. The multivariate Cox‐regression‐analysis confirmed the logistic EuroSCORE, EuroSCORE II, and the STS‐Score as independent predictors of long‐term mortality, whereas the SYNTAX‐Score (including residual form) and the CSS had no predictive value.

Conclusion

The EuroSCORE and the STS‐Score outperforms the SYNTAX‐Score and the CSS in predicting long‐term survival following MV‐PCI. In addition, the residual SYNTAX‐Score predicts long‐term survival not independently.

     

Percutaneous coronary intervention and 30‐day mortality: The British Columbia PCI risk score

Objectives : To construct a calculator to assess the risk of 30‐day mortality following PCI. Background : Predictors of 30‐day mortality are commonly used to aid management decisions for cardiac surgical patients. There is a need for an equivalent risk‐score for 30‐day mortality for percutaneous coronary intervention (PCI) as many patients are suitable for both procedures. Methods : The British Columbia Cardiac Registry (BCCR) is a population‐based registry that collects information on all PCI procedures performed in British Columbia (BC). We used data from the BCCR to identify risk factors for mortality in PCI patients and construct a calculator that predicts 30‐day mortality. Results : Patients (total n = 32,899) were divided into a training set (n = 26,350, PCI between 2000 and 2004) and validation set (n = 6,549, PCI in 2005). Univariate predictors of mortality were identified. Multivariable logistic regression analysis was performed on the training set to develop a statistical model for prediction of 30‐day mortality. This model was tested in the validation set. Variables that were objective and available before PCI were included in the final risk score calculator. The 30‐day mortality for the overall population was 1.5% (n = 500). Area under the ROC curve was 90.2% for the training set and 91.1% for the validation set indicating that the model also performed well in this group. Conclusions : We describe a large, contemporary cohort of patients undergoing PCI with complete follow‐up for 30‐day mortality. A robust, validated model of 30‐day mortality after PCI was used to construct a risk calculator, the BC‐PCI risk score, which can be accessed at www.bcpci.org . © 2009 Wiley‐Liss, Inc.     

SYNTAX积分预测冠心病复杂病变患者经皮冠状动脉介入治疗预后的作用

目的评价SYNTAX积分对冠心病3支病变和(或)左主干病变患者PCI预后的作用。方法经冠状动脉造影证实的3支病变和(或)左主干病变并接受PCI的患者1 90例。对每例患者造影结果进行SYNTAX评分,SYNTAX评分按三分位数分为:低分组、中分组和高分组,通过门诊或电话随访患者主要不良心脑血管事件(MACCE)。结果经PCI的冠心病3支病变和(或)左主干病变190例患者中,29例出现MACCE,发生率为15.3%。SYNTAX积分低分组、中分组及高分组的MACCE发生率分别为9.1%、1 6.2%及30.9%。Cox多因素分析显示,SYNTAX积分HR=2.07,95%CI:1.25～3.44,差异有统计学意义(P=0.005)。结论 SYNTAX积分是预测PCI预后的较理想工具,该积分系统也适用于我国冠心病3支病变和(或)左主干病变患者PCI术后预后的预测。