Risk Profile and 3-Year Outcomes From the SYNTAX Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting Nested Registries
Risk Profile and 3-Year Outcomes From the SYNTAX Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting Nested Registries
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DOI：
10.1016/j.jcin.2012.02.013
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发表时间：
2012-06-01
影响因子：
11.3
通讯作者：
Kappetein, A. Pieter
中科院分区：
文献类型：
--
作者：
Head, Stuart J.;Holmes, David R., Jr.;Kappetein, A. Pieter
目的评价经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)在不适合替代治疗的“现实世界”患者中的应用。背景目前还没有关于只能接受经皮冠状动脉介入治疗或冠状动脉旁路移植术的患者的风险分布和预后的数据。方法在SYNTAX(经皮冠状动脉介入治疗和冠状动脉旁路移植术与心脏外科手术之间的协同作用)试验中，一个多学科的心脏团队就经皮冠状动脉介入治疗和冠状动脉旁路移植术是否能导致临床平衡达成共识；如果是，则将患者随机分为两组。如果没有，患者被登记在冠状动脉旁路移植术不合格的冠状动脉搭桥术注册中心或冠状动脉旁路移植术不合格注册中心。CABG登记中的一部分(60%)患者被随机分配进行为期5年的随访。在随机和登记的患者之间没有进行统计学比较。主要不良心脑血管事件(MACCE)发生率仅供观察。结果共有3075名患者接受治疗，198名患者(6.4%)和1077名患者(35.0%)分别纳入了经皮冠状动脉介入治疗和冠状动脉旁路移植术。纳入冠状动脉搭桥术登记的主要原因是冠状动脉解剖太复杂(70.9%)，列入冠状动脉介入治疗登记的主要原因是手术风险太高(70.7%)。术后3年MACCE为38.0%，CABG后为16.4%。结论SYNTAX心脏研究小组得出结论：对于分别为6.4%和35.0%的患者而言，冠状动脉介入治疗和冠状动脉搭桥术仍然是唯一的治疗选择。接受经皮冠状动脉介入治疗的不能手术的主要合并症患者有较高的MACCE发生率。对于不适合经皮冠状动脉介入治疗的患者，手术效果良好。(语法研究：Taxus药物洗脱支架与冠状动脉旁路手术治疗狭窄动脉，NCT00114972)(J am Coll心脏ol Intv 2012；5：618-25)(C)2012，美国心脏病学会基金会
Objectives The aim of this study was to evaluate the use of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in "real-world" patients unsuitable for the alternative treatment.Background No data are available on the risk profile and outcomes of patients that can only undergo PCI or CABG.Methods In the SYNTAX (Synergy between PCI with TAXUS and Cardiac Surgery) trial, a multidisciplinary Heart Team reached a consensus on whether PCI and CABG could result in clinical equipoise; if so, the patient was randomized. If not, the patient was enrolled in a CABG-ineligible PCI registry or PCI-ineligible CABG registry. A proportion (60%) of patients in the CABG registry was randomly assigned to be followed up for 5 years. No statistical comparisons were performed between randomized and registry patients. Major adverse cardiac or cerebrovascular event (MACCE) rates are presented as observational only.Results A total of 3,075 patients were treated in the SYNTAX trial; 198 (6.4%) and 1,077 (35.0%) patients were included in PCI and CABG registries, respectively. The main reason for inclusion in the CABG registry was too complex coronary anatomy (70.9%), and the main reason for inclusion in the PCI registry was too high-risk for surgery (70.7%). Three-year MACCE was 38.0% after PCI and 16.4% after CABG. Stratification by SYNTAX score terciles demonstrated a step-wise increase of MACCE rates in both PCI and CABG registries.Conclusions The SYNTAX Heart Team concluded that PCI and CABG remained the only treatment options for 6.4% and 35.0% of patients, respectively. Inoperable patients with major comorbidities that underwent PCI had high MACCE rates. In patients not suitable for PCI, surgical results were excellent. (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries, NCT00114972) (J Am Coll Cardiol Intv 2012;5:618-25) (c) 2012 by the American College of Cardiology Foundation