Background: Residual SYNTAX score (rSS) and its derived indexes including SYNTAX revascularization index (SRI) and clinical rSS had been developed to quantify and describe the extent of incomplete revascularization. This study was conducted to explore the utility of the three scores among real-world patients after percutaneous coronary intervention (PCI).
Methods: From January 2013 to December 2013, patients underwent PCI treatment at Fuwai Hospital were included. The primary endpoints were all-cause death and major adverse cardiovascular and cerebrovascular events. The secondary endpoints were myocardial infarction, revascularization, stroke, and stent thrombosis. Kaplan-Meier methodology was used to determine the outcomes. Cox multivariable regression was to test the associations between scores and all-cause mortality.
Results: A total of 10,344 patients were finally analyzed in this study. Kaplan-Meier survival analysis indicated that greater residual coronary lesions quantified by rSS and its derived indexes were associated with increased risk of adverse cardiovascular events. However, after multivariate analysis, only clinical rSS was an independent predictor of 2-year all-cause death (hazard ratio: 1.02, 95% confidence interval: 1.01-1.03, P < 0.01). By receiver operating characteristic (ROC) curve analysis, clinical rSS had superior predictability of 2-year all-cause death than rSS and SRI (area under ROC curve [AUC]: 0.59 vs. 0.56 vs. 0.56, all P < 0.01), whereas rSS was superior in predicting repeat revascularization than clinical rSS and SRI (AUC: 0.62 vs. 0.61 vs. 0.61; all P < 0.01). When comparing the predictive capability of rSS ≥8 with SRI <70%, their predictabilities were not significantly different.
Conclusions: This study indicates that all three indexes (rSS, clinical rSS, and SRI) are able to risk-stratify patients and predict 2-year outcomes after PCI. However, their prognostic capabilities are different.
残余SYNTAX积分及其衍生积分对冠状动脉介入治疗术后患者预后影响的单中心大样本研究摘要背景: 残余SYNTAX积分 (rSS)及其衍生的SYNTAX血运重建指数(SRI)和临床残余SYNTAX积分 (CrSS)被用于评价不完全血运重建的程度。本研究在真实世界行冠状动脉介入治疗的大样本人群中，研究rSS, SRI及CrSS对不完全血运重建的评价价值以及其对患者远期预后的预测价值。 研究方法: 本研究连续纳入2013年1月至2013年12月在中国医学科学院阜外医院行冠状动脉介入治疗的患者。主要研究终点为全因死亡和主要心脑血管不良事件 (MACCE)。次要终点为再发心肌梗死、血运重建、卒中和支架内血栓。采用Kaplan-Meier法对临床终点进行生存分析，采用多因素COX回归分析比较三种积分与全因死亡的关系。使用受试者工作曲线比较三种不同积分对缺血事件的预测价值。 结果: 研究共纳入10,344例患者。Kaplan-Meier生存分析显示：rSS, SRI及CrSS评价的残余冠状动脉病变更重的患者，其缺血事件发生率更高。多因素分析显示：CrSS是全因死亡的独立危险因素 (HR: 1.02, 95% CI: 1.01-1.03; P<0.01)。 受试者工作曲线比较分析显示：CrSS比rSS和SRI对全因死亡的预测价值更高 (AUC: 0.59 vs. 0.56 vs. 0.56, P< 0.01)，而rSS比CrSS和SRI对再次血运重建的预测价值更高(AUC: 0.62 vs. 0.61 vs. 0.61; P< 0.01)。rSS ≥ 8分和SRI< 70%对全因死亡的预测价值相当 (AUC: 0.54, 95% CI: 0.53-0.55 vs. AUC:0.57, 95% CI: 0.56-0.58, P= 0.21)。 结论: rSS, CrSS和SRI三个评分均可用于冠状动脉介入治疗术后患者2年预后的危险分层。CrSS对全因死亡有一定的预测价值，rSS对再次血运重建有一定的预测价值。.
Keywords: Clinical Outcome; Percutaneous Coronary Intervention; Risk Assessment; Risk Stratification.