Objective The SYNTAX score(Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery,SS)is now broadly accepted to guide and predict mortality of complex coronary artery disease(CAD)patients un...Objective The SYNTAX score(Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery,SS)is now broadly accepted to guide and predict mortality of complex coronary artery disease(CAD)patients undergoing PCI or CABG.Recently,the clinical SYNTAX score which is a combination of age,ejection fraction,decrease in creatinine clearance and classic SYNTAX score,has been found to be superior in predicting adverse outcomes compared with the SYNTAX scores.Whether the clinical SS could help to determine which patients could be managed medically has never been explored.We sought to investigate the prognostic impact of the SS on long-term clinical outcomes in patients with three vessels disease undergoing medical therapy only.展开更多
Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain challenging.This study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy B...Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain challenging.This study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score II,and its association with the long-term prognosis after three strategies(percutaneous coronary intervention[PCI],coronary artery bypass grafting[CABG],and medical therapy[MT])in patients with TVD.Methods:This study was a post hoc analysis of a large,prospective cohort of patients with TVD in China,that aimed to determine the long-term outcomes after PCI,CABG,or optimal MT alone.A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital.A total of 7818 patients with available baseline LAVI data were included in the study.Baseline,procedural,and follow-up data were collected.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE),which was a composite of all-cause death,myocardial infarction(MI),and stroke.Secondary endpoints included all-cause death,cardiac death,MI,revascularization,and stroke.Long-term outcomes were evaluated among LAVI quartile groups.Results:During a median follow-up of 6.6 years,a higher LAVI was strongly associated with increased risk of MACCE(Q3:hazard ratio[HR]1.20,95%confidence interval[CI]1.06-1.37,P=0.005;Q4:HR 1.85,95%CI 1.64-2.09,P<0.001),all-cause death(Q3:HR 1.41,95%CI 1.17-1.69,P<0.001;Q4:HR 2.54,95%CI 2.16-3.00,P<0.001),and cardiac death(Q3:HR 1.81,95%CI 1.39-2.37,P<0.001;Q4:HR 3.47,95%CI 2.71-4.43,P<0.001).Moreover,LAVI significantly improved discrimination and reclassification of the SYNTAX score II.Notably,there was a significant interaction between LAVI quartiles and treatment strategies for MACCE.CABG was associated with lower risk of MACCE than MT alone,regardless of LAVI quartiles.Among patients in the fourth quartile,PCI was associated with significantly increased risk of cardiac death compared with CABG(HR:5.25,95%CI:1.97-14.03,P=0.001).Conclusions:LAVI is a potential index for risk stratification and therapeutic decision-making in patients with three-vessel coronary disease.CABG is associated with improved long-term outcomes compared with MT alone,regardless of LAVI quartiles.When LAVI is severely elevated,PCI is associated with higher risk of cardiac death than CABG.展开更多
文摘Objective The SYNTAX score(Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery,SS)is now broadly accepted to guide and predict mortality of complex coronary artery disease(CAD)patients undergoing PCI or CABG.Recently,the clinical SYNTAX score which is a combination of age,ejection fraction,decrease in creatinine clearance and classic SYNTAX score,has been found to be superior in predicting adverse outcomes compared with the SYNTAX scores.Whether the clinical SS could help to determine which patients could be managed medically has never been explored.We sought to investigate the prognostic impact of the SS on long-term clinical outcomes in patients with three vessels disease undergoing medical therapy only.
基金supported by National Program on Key Basic Research Project(973 Program,No.2010CB732601)National High-Tech Research and Development Program of China(863 Program,No.2015AA020407)+5 种基金Beijing Municipal Science&Technology Commission(No.Z191100006619106)National Natural Science Foundation of China(Nos.81470380 and 81770365)National Key Research and Development Program of the Ministry of Science and Technology of China during the"13^(th)Five-Year Plan"(No.2016YFC1301301)National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences(No.NCRC2020013)Key Project of Yunnan National Regional Medical Center for Cardiovascular Diseases(No.202002AA310100-14)Beijing United Heart Foundation(No.BJUHFCSOARF201901-19)
文摘Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain challenging.This study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score II,and its association with the long-term prognosis after three strategies(percutaneous coronary intervention[PCI],coronary artery bypass grafting[CABG],and medical therapy[MT])in patients with TVD.Methods:This study was a post hoc analysis of a large,prospective cohort of patients with TVD in China,that aimed to determine the long-term outcomes after PCI,CABG,or optimal MT alone.A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital.A total of 7818 patients with available baseline LAVI data were included in the study.Baseline,procedural,and follow-up data were collected.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE),which was a composite of all-cause death,myocardial infarction(MI),and stroke.Secondary endpoints included all-cause death,cardiac death,MI,revascularization,and stroke.Long-term outcomes were evaluated among LAVI quartile groups.Results:During a median follow-up of 6.6 years,a higher LAVI was strongly associated with increased risk of MACCE(Q3:hazard ratio[HR]1.20,95%confidence interval[CI]1.06-1.37,P=0.005;Q4:HR 1.85,95%CI 1.64-2.09,P<0.001),all-cause death(Q3:HR 1.41,95%CI 1.17-1.69,P<0.001;Q4:HR 2.54,95%CI 2.16-3.00,P<0.001),and cardiac death(Q3:HR 1.81,95%CI 1.39-2.37,P<0.001;Q4:HR 3.47,95%CI 2.71-4.43,P<0.001).Moreover,LAVI significantly improved discrimination and reclassification of the SYNTAX score II.Notably,there was a significant interaction between LAVI quartiles and treatment strategies for MACCE.CABG was associated with lower risk of MACCE than MT alone,regardless of LAVI quartiles.Among patients in the fourth quartile,PCI was associated with significantly increased risk of cardiac death compared with CABG(HR:5.25,95%CI:1.97-14.03,P=0.001).Conclusions:LAVI is a potential index for risk stratification and therapeutic decision-making in patients with three-vessel coronary disease.CABG is associated with improved long-term outcomes compared with MT alone,regardless of LAVI quartiles.When LAVI is severely elevated,PCI is associated with higher risk of cardiac death than CABG.
