Residual SYNTAX score after PCI for triple vessel coronary artery disease: quantifying the adverse effect of incomplete revascularisation

Abstract

The residual SYNTAX score is a useful method to quantify incomplete revascularisation in patients undergoing PCI for 3VD. Complete revascularisation (rSYNTAX=0) is achieved in only a minority and, for them, the mortality rate is low.

Prognostic impact of baseline and residual SYNTAX scores in cardiogenic shock

“…The distinctive improvement from bSS to rSS implies successful revascularization. However, the rate of complete revascularization (rSS 0) was lower than in prior studies and it was reached most often in patients with the lowest bSS. As complete revascularization is not always achievable in acute setting, previous studies have examined the concept of reasonable incomplete revascularization in ACS, but not in CS.…”

Prognostic impact of the residual SYNTAX score on in‐hospital outcomes in patients undergoing primary percutaneous coronary intervention

“…The rSS was subsequently validated in the SYNTAX cohort, where a high rSS (>8) conferred an increased risk of 5-year mortality [19]. In heterogeneous patient populations with MVD and unprotected left main disease, rSS has been associated with increased long-term mortality [20][21][22][23].…”

The incremental impact of residual SYNTAX score on long‐term clinical outcomes in patients with multivessel coronary artery disease treated by percutaneous coronary interventions

“…This approach divides the ICR according to a “greater” or “lesser” degree of completeness in search of a cutoff value to indicate “reasonable” ICR—which is non‐inferior (or even superior) to complete anatomic revascularization in regards to long‐term clinical outcomes . The current available tool for such an index is the residual SYNTAX score (rSS), which is calculated by subtracting the value of the lesions treated during the PCI from the pre‐revascularization SYNTAX score (SS).The rSS was shown to be an independent predictor of 1‐year ischemic events in patients with medium to high risk acute coronary syndrome , and of long‐term adverse outcomes in patients with 3VD (triple‐vessel) and left main (LM) coronary disease undergoing PCI. A post hoc analysis of the PCI arm of the SYNTAX trial showed that a rSS ≤ 8 was associated with a similar long‐term clinical prognosis as complete anatomic revascularization and only patients with rSS > 8 experienced more adverse outcomes , suggesting a rSS cutoff value of 8 as a standard for “reasonable” ICR.…”