ApPropriateness of myocaRdial RevascularizatiOn assessed by the SYNTAX score II in a coUntry without cardiac Surgery faciliTies; PROUST study

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• 作者：Bojan M. Stanetic^a ; ¹ ; Miodrag Ostojic^a ; ^b ; ^c ; ¹ ; ^{mostojic2011@gmail.com} ; Carlos M. Campos^d ; ^e ; ¹ ; Jelena Marinkovic^f ; ¹ ; Vasim Farooq^g ; ¹ ; Tamara Kovacevic-Preradovic^a ; ¹ ; Kurt Huber^h ; ¹ ; Patrick W. Serruysⁱ ; ¹
• 关键词：CABG ; Coronary artery bypass grafting ; CAD ; Coronary artery disease ; CI ; Confidence interval ; COPD ; Chronic obstructive pulmonary disease ; eGFR ; Estimated glomerular filtration rate ; ESC ; European Society of Cardiology ; LVEF ; Left ventricular ejection fraction ; PCI ; Percutaneous coronary intervention ; Q1 ; First quartile ; Q3 ; Third quartile ; SD ; Standard deviation ; SSII ; SYNTAX Score II ; SYNTAX ; Synergy between percutaneous coronary intervention with Taxus and cardiac surgery ; UCC RS ; University
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：227
• 期：Complete
• 页码：478-484
• 全文大小：700 K
• 卷排序：227

文摘

The SYNTAX Score II (SSII) was proposed as a novel approach for objective individualized decision-making for optimal myocardial revascularization i.e. percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. We sought to investigate how many lives may be saved by SSII use.MethodsA total number of 651 consecutive SSII-naive-patients with complex coronary artery disease who were treated with PCI (n = 409) or referred to other institutions for CABG (n = 242) were included. All-cause mortality was ascertained in 96% of patients. The SSII was calculated for each patient.ResultsBased on the SSII treatment recommendation, CABG would have been the treatment of choice in 257/651 (39.5%) patients, PCI in 7/651 (1.1%) patients and CABG or PCI in 387/651 (59.4%) patients. Out of 257 patients in whom the treatment recommendation by SSII was CABG, 113/257 (44.0%) patients had actually CABG, while the remaining 144/257 (56.0%) underwent PCI. It was shown that 144/257 patients with treatment recommendations in favour of CABG who were treated with PCI had significantly higher mortality at 4 years when compared with patients with SSII treatment recommendation for PCI or equally favouring CABG and PCI (12.5% vs. 0.0% vs. 6.9%, respectively, P = 0.04).ConclusionThe intuitive decision-making for choosing the optimal myocardial revascularization method differed predominantly from the SSII recommendation for CABG. The discordance between the SSII recommended revascularization strategy and the clinical decision was associated with a higher 4-year mortality i.e. one life may be saved if SSII would be calculated and followed consequently in 18 patients.