- 作者：Young-Hak Kim ; MD ; PhD?/sup> ; Duk-Woo Park ; MD ; PhD?/sup> ; Won-Jang Kim ; MD?/sup> ; Jong-Young Lee ; MD?/sup> ; Sung-Cheol Yun ; PhD&dagger ; ; Soo-Jin Kang ; MD ; PhD?/sup> ; Seung-Whan Lee ; MD ; PhD?/sup> ; Cheol Whan Lee ; MD ; PhD?/sup> ; Seong-Wook Park ; MD ; PhD?/sup> ; Seung-Jung Park ; MD ; PhD?/sup> ; sjpark@amc.seoul.kr
- 关键词：coronary artery bypass graft surgery ; coronary artery disease ; prediction ; stent
- 刊名：JACC: Cardiovascular Interventions
- 出版年：2010
- 出版时间：June 2010
- 年：2010
- 卷：3
- 期：6
- 页码：612-623
- 全文大小：1048 K
Objectives
This study aimed to validate the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score representing angiographic complexity after unprotected left main coronary artery (ULMCA) revascularization.Background
The validity of the SYNTAX score has been adequately evaluated.
Methods
The SYNTAX scores were calculated for 1,580 patients in a large multicenter registry who underwent percutaneous coronary intervention (PCI) (n = 819) or coronary artery bypass graft (CABG) (n = 761) for ULMCA stenosis. The outcomes of interests were 3-year incidences of major adverse vascular events (MAVE), including death, Q-wave myocardial infarction, and stroke and major adverse cardiac and cerebrovascular events (MACCE), including MAVE and target vessel revascularization of ULMCA.
Results
The incidence of 3-year MAVE was 6.2 % in the lowest (?3), 7.1 % in the intermediate (23 to ?6), and 17.4 % in the highest (>36) SYNTAX score tertile groups after PCI (p = 0.010). However, the incidences of MAVE in the CABG group and MACCE in the PCI and CABG groups did not differ among the SYNTAX tertiles. In subgroups, the MAVE (p = 0.005) and MACCE (p = 0.007) rates according to the SYNTAX score tertiles were significantly different in patients receiving drug-eluting stent, not in those receiving bare-metal stent. When compared with the clinical EuroSCORE (European System for Cardiac Operative Risk Evaluation), the C-indexes of SYNTAX score and EuroSCORE were 0.59 and 0.67, respectively, for discrimination of MAVE and 0.53 and 0.57, respectively, for MACCE.
Conclusions
The angiographic SYNTAX score seems to play a partial role in predicting long-term adverse events after PCI for ULMCA stenosis. A complementary consideration of patient's clinical risk might improve the predictive ability of risk score.