重新开发和验证SYNTAX评分II以使复杂冠状动脉疾病患者的皮肤和手术重血管化之间的决策更加个性化:多中心随机对照SYNTAXES试验的二次分析
Kuniaki Takahashi1, Patrick W Serruys2, Valentin Fuster3
1Department of Cardiology, Amsterdam Universities Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
Lancet (London, England)
|October 11, 2020
概括
一个新的工具,SYNTAX评分II 2020,有助于预测复杂冠状动脉疾病患者的结果. 它指导了穿皮冠状动脉干预 (PCI) 和冠状动脉旁路移植 (CABG) 之间最佳的再血管化策略选择.
科学领域:
- 心脏病学
- 干预心脏病学
- 心血管外科
背景情况:
- 随机对照试验 (RCT) 通常报告平均治疗效果,这可能不是个体患者的最佳决定.
- 对于患有复杂冠状动脉疾病的患者来说,治疗结果可能有很大差异.
- 需要个性化的决策工具来优化复血管化策略.
研究的目的:
- 开发一个个性化的决策工具来选择最佳的血管恢复策略.
- 在患有复杂冠状动脉疾病的患者中预测10年全因死亡和5年重大心血管不良事件 (MACE).
- 通过皮肤进行冠状动脉干预 (PCI) 与冠状动脉旁路移植 (CABG) 的疗效进行比较.
主要方法:
- 使用了来自SYNTAX延长生存 (SYNTAXES) 研究的数据,这是一个多中心的RCT延长.
- 通过考克斯回归来开发了10年死亡率的临床预后指数.
- 将综合治疗 (PCI与CABG) 和效果修饰剂 (疾病类型,解剖学SYNTAX评分) 纳入SYNTAX评分II 2020.
- 使用SYNTAX试验进行交叉验证,并使用FREEDOM,BEST和PRECOMBAT试验进行外部验证来验证该模型.
主要成果:
- 在PCI和CABG组中,SYNTAX评分II 2020显示出有助于预测10年全因死亡 (C指数=0. 73) 和5年MACE (C指数=0. 65- 0. 71).
- 外部验证证实有助于预测5年MACE的区分和良好校准.
- 与PCI相比,CABG对患者的治疗益处在患者之间有很大差异,预测得到了良好的校准.
结论:
- 2020年SYNTAX评分是预测复杂冠状动脉疾病患者的结果的有价值工具.
- 它有助于心脏团队,患者和家人选择最佳的复血管化策略 (PCI与CABG).
- 这种工具支持个性化治疗决策,不仅仅是平均治疗效果.
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