Value of SYNTAX revascularization index on evaluating the long?term prognosis of coronary artery disease patients with biodegradable polymer drug?eluting stents implantation
10.3760/cma.j.issn.0253?3758.2019.10.005
- VernacularTitle:基于SYNTAX血运重建指数评价置入生物可降解涂层药物洗脱支架冠心病患者的长期临床预后
- Author:
Miaohan QIU
1
;
Liya BIAN
;
Chu＇ai FANG
;
Peng FAN
;
Weichao ZHAO
;
Jing LI
;
Yi LI
;
Yaling HAN
Author Information
1. 北部战区总医院心血管内科
- Keywords:
Coronary artery disease;
Percutaneous coronary intervention;
SYNTAX revascularization index;
Biodegradable polymer drug?eluting stents
- From:
Chinese Journal of Cardiology
2019;47(10):790-797
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the value of SYNTAX revascularization index (SRI) on evaluating the long?term prognosis of coronary artery disease (CAD) patients implanted with biodegradable polymer drug?eluting stents (BP?DES) and define the best threshold of SRI for predicting all?cause mortality in these patients. Methods Data used in this study derived from the I?LOVE?IT 2 trial (evaluate safety and effectiveness of the Tivoli DES and the Firebird DES for treatment of coronary). I?LOVE?IT 2 trial was a prospective, multicenter, randomized, assessor?blinded, non?inferiority study. A total of 1 829 patients implanted with BP?DES were divided into 3 groups, namely SRI=100% group (n=963), 50%≤SRI<100% group (n=527) and SRI<50% group (n=339). The primary endpoint was 48?month patient?oriented composite endpoint (PoCE), a composite of all?cause mortality, myocardial infarction(MI), stroke, and / or any revascularization. The secondary endpoints were components of PoCE and definite/probable stent thrombosis at 48 months. The receiver operating characteristic curve was used to investigate the best cut?off point of SRI for 48?month all?cause mortality. The Cox regression analysis was used to identify independent predictors of the all?cause death and PoCE at 48 months. Results Incidence of PoCE at 48 months was significantly lower in SRI=100% group than patients with 50%≤SRI<100%(17.34% (167/963) vs. 22.20% (117/527), P<0.05) and SRI<50% (17.34% (167/963) vs. 24.78% (84/339), P<0.05). Comparing with SRI=100% group, the patients with 50%≤SRI<100% suffered higher rates of all MI (7.78% (41/527) vs. 4.26% (41/963), P<0.05) and target vessel MI (6.45% (34/527) vs. 4.26% (41/963), P<0.05); patients with SRI<50% had higher rates of all?cause mortality (5.90% (20/339) vs. 3.12% (30/963), P<0.05) and any revascularization (14.16% (48/339) vs. 3.12% (30/963), P<0.05). The receiver operating characteristic curve analysis showed that the SRI=65% was the best cut?off point to predict the all?cause mortality at 48 months (area under the curve was 0.58, sensitive was 0.47, specificity was 0.70). Meanwhile, SRI<65% was an independent predictor of 48?month all?cause mortality ( HR=2.06, 95%CI 1.25-3.38) and PoCE ( HR=1.34, 95%CI 1.09-1.66). Conclusions SRI serves as a good index for predicting long?term prognosis and SRI<65% is an independent predictor of 48?month PoCE and all?cause mortality for CAD patients with BP?DES implantation. Meanwhile, SRI≥65% might be a reasonable threshold of incomplete revascularization.
