| Objective This study sought to evaluate the long-term prognostic capacity of the SYNTAX score(SS)and SYNTAX score Ⅱ(SS-Ⅱ)and illustrate the risk factors of the MACE among patients with CABG.Methods During a period of 10 years between January 2008 to December 2018,data from 308 patients from Tianjin Chest Hospital referred to coronary artery bypass grafting(CABG)were collected.The SS and SS-Ⅱ for each patient were caculated.Patients were stratified into low(SS and SS-Ⅱ<23),middle(23-32)and high(SS and SS-Ⅱ>32)groups according to 2018 ESC/EACTS Guidelines on myocardial revascularization and the previous research.The baseline characteristics and Coronary artery disease were analyzed.The median follow-up time was 63 months.The primary endpoint was MACE,which included all-cause death,MI and repeat revascularization throughout the follow-up period after the operation.The secondary endpoints were components of MACE.Kaplan-Meier survival analysis,ROC curve and COX regression analysis were used to evaluate the prognostic value of SS and SS-Ⅱ for MACE and its components.The clinical variables were also included in the analysis to illustrate the relevance to MACE among patients undergoing CABG.Results(1)Among 308 patients(mean age: 64.73 ± 8.20 years),73.1%(225/308)were male.During follow-up(median: 64 months),the range of SS was 11～82,with the median was 30.Among three groups according to SS,there were 69 cases in the low group,which including 9 cases of MACE,8 cases of revascularization and 1 case of non-fatal MI.There were 109 cases in the middle group,which including 29 cases of MACE,28 cases of revascularization and 5 cases of non-fatal MI.There were 130 cases in the high group,which including 56 cases of MACE,47 cases of revascularization and 22 cases of non-fatal MI.The range of SS-Ⅱ was 2.1～58.8,with the median was 23.4.Among three groups according to SS-Ⅱ,there were 107 cases in the low group,which including 14 cases of MACE,11 cases of revascularization and 3 case of non-fatal MI.There were 99 cases in the middle group,which including 24 cases of MACE,23 cases of revascularization and 4 cases of non-fatal MI.There were 102 cases in the high group,which including 56 cases of MACE,49 cases of revascularization and 21 cases of non-fatal MI.(2)Among three groups according to SS,no significant differences were found in gender,age,BMI,the complication of the diabetes,hypertension and cerebrovascular /peripheral vascular disease,the history of myocardial infarction,PCI and family history of CHD and in the blood pressure,Glycated hemoglobin,blood lipid,CRP,and homocysteine.Compared with lower groups,there were more smokers,patients with lower ejection fraction and creatinine clearance,larger left ventricular end diastolic diameter,higher NT-pro BNP and SYNTAX score Ⅱ,and shorter survival time.Among three groups according to SS,no significant differences were found in BMI,the complication of the diabetes,hypertension and cerebrovascular /peripheral vascular disease,the history of smoking,myocardial infarction and PCI,family history of CHD,and in the blood pressure,glycated hemoglobin,blood lipid,CRP and homocysteine.Compared with lower groups,there were more elders,more frequently female,patients with lower ejection fraction and creatinine clearance,larger left ventricular end diastolic diameter,higher NT-pro BNP and SYNTAX score,and shorter survival time.(3)During the follow-up period,the rate of MACE was 30.5%.Among 91 patients who completed coronary angiography,63.7% were bridging vascular lesions,23.1% were progression of orthotopic coronary artery and 13.2% had lesions in both.Among 83 patients who completed revascularization,a total of 131 stents were implanted,which including 72 cases of PCI in coronary artery,10 cases of PCI in saphenous vein bridge,and 1 case of re-CABG.The rate of non-fatal MI in the cohort was 9.1%.Only one patient died,the cumulative incidence of death was 0.32%.(4)Kaplan-Meier survival illustrated that according to either SS or SS-Ⅱ,the rate of MACE,non-fatal MI and revascularization was significantly higher(P <0.05 for both)in the high group than that in the intermediate or low groups.(5)ROC curve analysis showed that SS and SS-Ⅱ were realible predictors of MACE non-fatal MI and revascularization.The AUC of MACE for SS-Ⅱ[AUC 0.751(0.692,0.809),P<0.001] was significantly(P=0.026)larger than that for SS[AUC 0.664(0.599,0.729),P<0.001].The AUC of revascularization for SS-Ⅱ[AUC 0.743(0.683,0.804),P<0.001] was significantly(P=0.005)larger than that for SS[AUC 0.626(0.560,0.693),P=0.001].No difference was found between AUCs of non-fatal MI for SS[AUC 0.750(0.663,0.836),P<0.001] and SS-Ⅱ [AUC 0.775(0.683,0.866),P<0.001](P=0.349).(6)Multivariate COX regression showed that grouping by SS,MACE occurred in 13.0% of low group,26.6% of mid group and 43.1% of high group(HR for low vs high 0.226,95%CI 0.124～0.411,P<0.001;HR for mid vs high 0.582,95%CI 0.353～0.961,P=0.034).According to SS-Ⅱ,MACE occurred in 13.1% of low group,24.2% of mid group and 54.9% of high group(HR for low vs high 0.196,95%CI 0.106～0.362,P<0.001;HR for mid vs high 0.459,95%CI 0.279～0.755,P=0.002).Conclusion This study demonstrates that the prognostic value of either SS or SS-Ⅱ is valid and SS-Ⅱ provide more effective risk assessment,especially for MACE and revascularization for patients undergoing CABG. |
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