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 gments（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 gment 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 coronary artery distal to the crux.
16a. Posterolateral branch from RCA: First posterolateral branch from gment 16.
16b. Posterolateral branch from RCA: Second posterolateral branch from gment 16.
16c. Posterolateral branch from RCA: Third posterolateral branch from gment 16.
5. Left main: From the ostium of the LCA through bifurcation into left anterior descending and left circumflex branches.
6. LAD proximal: Proximal to and including first major ptal branch.
7. LAD mid: LAD immediately distal to origin of first ptal branch and extending to the point where LAD forms an angle (RAO view). If this
angle is not identifiable this gment ends at one half the distance from the first ptal to the apex of the heart.
8. LAD apical: Terminal portion of LAD, beginning at the end of previous gment and extending to or beyond the apex.
9. First diagonal: The first diagonal originating from gment 6 or 7.
9a. First diagonal a: Additional first diagonal originating from gment 6 or 7, before gment 8.
10. Second diagonal: Originating from gment 8 or the transition between gment 7 and 8.
10a. Second diagonal a: Additional cond diagonal originating from gment 8.
11. Proximal circumflex artery: Main stem of circumflex from its origin of left main and including origin of first obtu marginal branch.
12. Intermediate/anterolateral artery: Branch from trifurcating left main other than proximal LAD or LCX. It belongs to the circumflex territory.
12a. Obtu marginal a: First side branch of circumflex running in general to the area of obtu margin of the heart.
12b. Obtu marginal b: Second additional branch of circumflex running in the same direction as 12.
13. Distal circumflex artery: The stem of the circumflex distal to the origin of the most distal obtu marginal branch, and running along the posterior
left atrioventricular groove. Caliber may be small or artery abnt.
14. Left posterolateral: Running to the posterolateral surface of the left ventricle. May be abnt or a division of obtu marginal branch.
14a. Left posterolateral a: Distal from 14 and running in the same direction.
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 prent. It gives origin to ptal branches. When this arteryis prent, gment 4 is usually abnt。
SYNTAX 评分方法是基于下面的分级系统发展出来的：
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：
Syntax 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。12个月CABG组累积MACCE率为14.4%（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。
