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1、08年长城会上听专家讲了 Syntax score评分方法，这评分方法比较复杂，主要是依据冠脉造影的 结果来判断。在准备阅读之前，先要熟悉冠脉解剖的节段分布情况：（上图为左优势型冠脉解剖分布,下图为右优势型解剖分布）Figure 1。 Definition of the coronary tree segments （冠脉束血管段的识别）1. RCA proximal： From the ostium to one half the distance to the acute margin of the heart.2。RCA mid： From the end of first segmen
2、t to acute margin of heart.3. RCA distal: From the acute margin of the heart to the origin of the posterior descending artery。4. Posterior descending artery: Running in the posterior interventricular groove.16. Posterolateral branch from RCA: Posterolateral branch originating from the distal coronar
3、y artery distal to the crux.16a。 Posterolateral branch from RCA: First posterolateral branch from segment 16。16b。 Posterolateral branch from RCA: Second posterolateral branch from segment 16。16c。 Posterolateral branch from RCA: Third posterolateral branch from segment 16。5。Left main: From the ostium
4、 of the LCA through bifurcation into left anterior descending and left circumflex branches.6。LAD proximal: Proximal to and including first major septal branch.7。LAD mid: LAD immediately distal to origin of first septal branch and extending to the point where LAD forms an angle （RAO view）。 If thisang
5、le is not identifiable this segment ends at one half the distance from the first septal to the apex of the heart.8. LAD apical: Terminal portion of LAD， beginning at the end of previous segment and extending to or beyond the apex.9。First diagonal: The first diagonal originating from segment 6 or 7.9
6、a. First diagonal a： Additional first diagonal originating from segment 6 or 7, before segment 8。10. Second diagonal: Originating from segment 8 or the transition between segment 7 and 8。10a。 Second diagonal a: Additional second diagonal originating from segment 8.11. Proximal circumflex artery: Mai
7、n stem of circumflex from its origin of left main and including origin of first obtuse marginal branch.12。Intermediate/anterolateral artery： Branch from trifurcating left main other than proximal LAD or LCXo It belongs to the circumflex territory.12a。 Obtuse marginal a: First side branch of circumfl
8、ex running in general to the area of obtuse margin of the heart.12b. Obtuse marginal b: Second additional branch of circumflex running in the same direction as 12。13o Distal circumflex artery： The stem of the circumflex distal to the origin of the most distal obtuse marginal branch, and running alon
9、g the posterior left atrioventricular groove o Caliber may be small or artery absent。14. Left posterolateral: Running to the posterolateral surface of the left ventricle. May be absent or a division of obtuse marginal branch.14a. Left posterolateral a: Distal from 14 and running in the same directio
10、n。14b。 Left posterolateral b: Distal from 14 and 14 a and running in the same direction。15. Posterior descending: Most distal part of dominant left circumflex when present. It gives origin to septal branches. When this arteryis present, segment 4 is usually absent.Left dominanceSYNTAX评分方法是基于下面的分级系统发
11、展出来的:1。根据ARTS研究修改的关于冠脉树血管段的AHA分级；2。Leaman 评分；3。ACC/AHA病变分级系统；4。完全闭塞分型系统；5。Duke和ICPS分支病变分型系统；6. 专家的意见。现在介绍这个评分系统的具体内容，并结合病例来说明，注意一定要结合上述图上的血管段分级:Table L Segment weighing factors :物;警节段;极重顷Segment MoRight dominanceLeft doniiinance1右冠近段10芝右冠中段101右秘匹段104 后降支动疏1乩瓦就来自RCA的后调分支Q.5n.a.皿亲自RW樗后倒分支O-Hn_a_至功来自RC
12、A的后御分支0.5n.a.s 束自RCA德后fill分支0-a5Cd5左主干56s LAD近段3.53.57 LAD中段fe.52.5B LAD心尖蓄119第一对伟支119a筹一对角支曰11上。第二对角支0-.50.5皿笫二对用支a0.50.5中叵旋支近段1.52.5箪中问女或酣佩女司1膝11123钝缘支氏1112b饨壕支bn113回旋支远段0.51.514-左室后例支0.5114a左室后AS支ai0.51也5左室后ffij支b0.5115后降麦n.a.1Syntax score临床意义:1) SYNTAX评分值较低的组：0到22分：研究数据显示通过PCI和CABG实现再血管化有相近的预后.1
13、2个月CABG组累积MACCE率为1 4.4%(n=247), TAXUS 支架组为 13.5% (n=299； P=0.71)。SYNTAX评分值22分的患者的治疗策略可以基于患者的个体病情特点、患者自己的意愿以及 医生的判断，此时PCI和CABG均可。2) SYNTAX评分值在23至32之间：12个月累积MACCE率在CABG组为11。7%(n=300),TAXUS组为16.6%(n=310； P=0.10).从中可见这些不良事件在PCI组轻微增加，但不显著。这表明PCI在SYNTAX评分中等的患者仍然是可以选择的。最终选择何种治疗策略取决于患者 的特点和伴随疾病情况。3) SYNTAX评
14、分值高(233):直接导致12个月时PCI组明显增高的MACCE 率.CABG组为10。7%(n=316), TAXUS 组为 23.3%(n=290; P.001)这些患者解剖上十分复杂，从MACCE率表明PCI对于这群患者并不是个好选择，他们应该作为 外科的候选者，此时应选择CABG。SYNTAX实验的结果表明55%的患者仍然最好应选择CABG，然而，对于余下的患者采用PCI也是非常好的。具体举例：见病变1：1）为左主干病变，对应血管段为5,对应权重为5分，由于为严重狭窄病变，应乘于2才是最后得分：5*2=10分；2）这个左主干病变为分叉前的病变，判断为type A分叉病变，得1分；3）存
15、在严重的钙化，2分 此病变共：10+1+2=13分.病变2：1）为前降支近段重度狭窄，对应血管段为6,对应权重为3.5分，由于为严重狭窄病变，应乘于2才是最后得分：3.5*2=7分；2）这个左前降支病变为分叉前的病变，判断为type A分叉病变，得1分；3）成角70度，1分；4）存在严重的钙化,2分此病变共：7+1+1+2=11分。病变3:1）为回旋支病变，对应血管段为11，对应权重为1。5分，由于为闭塞病变,应乘于5才是最后得分：1。5 大 5=7.5 分；2）闭塞时间不明,1分；3）闭塞残断钝,1分；4）边支血管累及,1分；5）闭塞以远段侧枝显影后可见血管段13（回旋支远段）显影，1分；6
16、）存在严重的钙化，2分；7）闭塞长度大于20mm,1分；此病变共：7。5+1+1+1+1+2+1=14。5 分.病变4：1）为右冠近段病变，对应血管段为1,对应权重为1分，由于为闭塞病变，应乘于5才是最后得分：1*5=5 分；2）闭塞时间不明，1分；3）闭塞残断钝,1分；4）边支血管累及，1分；5）闭塞以远段侧枝显影后可见血管段4 （后降支）显影，3分；6）扭曲病变，2分；7）闭塞长度大于20mm,1分；8）存在严重的钙化，2分；此病变共：5+1+1+1+3+2+2+1=16 分。一共：13+11+14。5+16=54.5分。大于33分，适合CABG，如果行PCI的话,那么可能增加不良事 件发
17、生。有个网页，在这里面它有个计算器。进去可以给你所做PCI手术.进 行 syntax评分。CALCULATORStart using the calcuiaiorwhenStan caicuiator.的红点击该页面的:you have successfuliy completed the tutorial.色 start calculator1IMPUKIANI INIbUKMAIlUHThe SYNTAX Score is a tool developed in connertion with the SYNTAX Triali a trial comparing PCI and Card
18、iac Surgery in complex, high-risk LM and/or 3VD patiants. It is important to note that the safety nnd effectiveness of drug-eluting stents have not been established in th&e liigh risk patients! and physicians are strongly encouraged to review the indications, contraindications, warnings and instruct
19、ions induded in the products Directions for Use.The SYNTAX Score and related materials are not intended to provide medical advice or guidance as to appropriate treatment strateoies for individual patients. Risks and benefits should be 匚 a ref u II y considered far each patient taking into account al
20、l a/ailable:Z! 了白马 I have Fully read the Important Information abc/s.ProceedClofe catciflEatorYes 打勾。点 proceed。SYN IAX SCORESelect dominance Conoriarv systemLeft dounl nanceRight dominance选择你的病人 CA 结果的优势类型点击就行了CjK* on the canary tree rrnage to refect or an网城 sediments-Segments:RCA. R.CA prcxinialiRC
21、A mid2RCA distal3Posterior descending4Patflrolateral from RCA16aPastrDlat；ral from RCA16aPostrijlaterdl from RCAI6bPosterolateral from RCA16c回LM Left main5LAO LAD prowmal6LAD mid7LAD apicalSFret diagonal9回Ad.d. first dim皿ml9aSecond diaganial104dds second diagonal10adLCK Proximal circumflex11nIntermediate/anterolateral12Cbtue margnal12B回Obtuse niardpnal12bnDietal drcumllesf13Left posteralatenalLeft posterolateral14aLeft posterolateral14b2JLesion:tWKt后面的就照CA结果填表就行。点NEXT.。再到最后会给syntax score给你。就完成了。根据这里的评分选项，就可以完全了解它的评分系统及结构框架。
