Validation of the SYNTAX Revascularization Index to Quantify Reasonable Level of Incomplete Revascularization After Percutaneous Coronary Intervention

被引：37

作者：

Genereux, Philippe ^{[1
,2
,3
,4
]}

Campos, Carlos M. ^{[5
,6
]}

Farooq, Vasim ^{[5
]}

Bourantas, Christos V. ^{[5
]}

Mohr, Friedrich W. ^{[7
]}

Colombo, Antonio ^{[8
]}

Morel, Marie-Angele ^{[5
]}

Feldman, Ted E. ^{[9
]}

Holmes, David R., Jr. ^{[10
]}

Mack, Michael J. ^{[11
]}

Morice, Marie-Claude ^{[12
]}

Kappetein, A. Pieter ^{[5
]}

Palmerini, Tullio ^{[13
]}

Stone, Gregg W. ^{[1
,2
,3
]}

Serruys, Patrick W. ^{[5
,14
]}

机构：

[1] New York Presbyterian Hosp, New York, NY USA

[2] Columbia Univ, Med Ctr, New York, NY USA

[3] Cardiovasc Res Fdn, New York, NY USA

[4] Univ Montreal, Hop Sacre Coeur Montreal, Montreal, PQ, Canada

[5] Erasmus Univ, Thoraxctr, Dept Intervent Cardiol, Med Ctr, NL-3000 DR Rotterdam, Netherlands

[6] Univ Sao Paulo, Sch Med, Dept Intervent Cardiol, Heart Inst InCor, Sao Paulo, Brazil

[7] Klin Herzchirurg, Leipzig, Germany

[8] Hosp San Raffaele, Columbus Hosp, I-20132 Milan, Italy

[9] Northwestern Univ, Evanston Hosp, Div Cardiol, Evanston, IL 60201 USA

[10] Mayo Clin, Rochester, MN USA

[11] Baylor Healthcare Syst, Dallas, TX USA

[12] Inst Cardiovasc Paris Sud, Paris, France

[13] Univ Bologna, Ist Cardiol, Policlin S Orsola, Bologna, Italy

[14] Univ London Imperial Coll Sci Technol & Med, Int Ctr Circulatory Hlth, NHLI, London, England

来源：

AMERICAN JOURNAL OF CARDIOLOGY | 2015年 / 116卷 / 02期

关键词：

CARDIAC-SURGERY SYNTAX; ARTERY-DISEASE; CLINICAL-OUTCOMES; MEDICAL THERAPY; FOLLOW-UP; BYPASS; SYNERGY; TAXUS; SCORE; IMPACT;

D O I：

10.1016/j.amjcard.2015.03.056

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Incomplete revascularization is common after percutaneous coronary intervention (PCI). Whether a "reasonable" degree of incomplete revascularization is associated with a similar favorable long-term prognosis compared with complete revascularization remains unknown. We sought to quantify the proportion of coronary artery disease burden treated by PCI and evaluate its impact on outcomes using a new prognostic instrument the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) Revascularization Index (SRI). The baseline SYNTAX score (bSS), the residual SYNTAX score, and the delta SYNTAX score (Delta SS) were determined from 888 angiograms of patients enrolled in the prospective SYNTAX trial. The SRI was then calculated for each patient using the following formula: SRI = (Delta SS/bSS]) x 100. Outcomes were examined according to the proportion of revascularized myocardium (SRI = 100% [complete revascularization], 50% to <100%, and <50%). The Youden index for the SRI was computed to identify the best cutoff for 5-year all-cause mortality. The mean bSS was 28.4 +/- 11.5, and after PCI, the mean Delta SS was 23.8 +/- 10.9 and the mean residual SYNTAX score was 4.5 +/- 6.9. The mean SRI was 85.3 +/- 21.2% and was 100% in 385 patients (43.5%), <100% to 50% in 454 patients (51.1%), and <50% in 48 patients (5.4%). Five-year adverse outcomes, including death, were inversely proportional to the SRI. An SRI cutoff of <70% (present in 142 patients [16.0%] after PCI) had the best prognostic accuracy for prediction of death and, by multivariable analysis, was an independent predictor of 5-year mortality (hazard ratio [HR] 4.13, 95% confidence interval [CI] 2.79 to 6.11, p <0.0001). In conclusion, the SRI is a newly described method for quantifying the proportion of coronary artery disease burden treated by PCI. The SRI is a useful tool in assessing the degree of revascularization after PCI, with SRI 70% representing a "reasonable" goal for patients with complex coronary artery disease. (C) 2015 Elsevier Inc. All rights reserved.

引用

页码：174 / 186

页数：13

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