SYNTAX Score-II Predicts Long-Term Mortality in Patients Who Underwent Left Main Percutaneous Coronary Intervention Treated With Second-Generation Drug-Eluting Stents

Abstract

SummaryThe aim of this study was to evaluate the capacity of the SYNTAX Score-II (SS-II) to predict long-term mortality in patients undergoing left main percutaneous coronary intervention (LM-PCI) treated with second-generation drug-eluting stents (DES).Data from 487 consecutive patients with de novo left main coronary artery disease undergoing PCI were retrospectively studied. The patients were divided into tertiles according to the SS-II: low SS-II tertile (SS-II ≤ 22), intermediate SS-II tertile (SS-II of 23 to 30), and high SS-II tertile (SS-II ≥ 30). The survival curves were estimated by the KaplanMeier method. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the possible associations between the SS-II and the rates of long-term mortality. The predictive ability of the SS-II for mortality was assessed and compared with the SYNTAX score (SS) alone by an area under the receiver operator curve (AUC).The overall SS-II was 27.3 ± 9.1. At a mean follow-up of 5.1 years, the long-term mortality was 6.0%. The rates of mortality were 2.4%, 3.4%, and 11.6%, respectively (P < 0.0001) in the low, intermediate, and high SS-II tertiles. The cardiac mortality rates were 1.8%, 1.4%, and 8.1%, respectively (P = 0.002) among patients in the 3 groups. By multivariate analysis, SS-II was an independent predictor of the long-term mortality (hazard ratio: 1.56, 95% confidence interval: 1.05 to 2.32; P = 0.03). The AUC demonstrated a substantially higher predictive accuracy of the SS-II for mortality compared with the SS alone (AUC was 0.689 and 0.596, respectively).In patients with LM-PCI treated with a second-generation DES, the SS-II is an independent predictor of long-term mortality and demonstrates a superior predictability compared with the SS alone. (Int Heart J 2017; 58: 344-350) Key words: Left main coronary artery disease, Predict T he SYNTAX score II (SS-II) was recently developed by applying a Cox proportional hazards model to the results of the SYNTAX trial data. The SS-II incorporates a combination of two anatomical (anatomical SS and left main coronary artery disease) and 6 clinical variables (age, sex, left ventricular ejection fraction, creatinine clearance, chronic obstructive pulmonary disease, and peripheral vascular disease).1) The SS-II has been shown to provide reliable predictions of 4-year mortality for complex coronary artery disease (CAD), being internally validated in the landmark, all-comers, randomized SYNTAX trial 1,2) and externally applied in two real world registries.3,4) Therefore, the SS-II provides an impartial, evidence-based assessment of the decision-making process for clinicians weighing anatomical and clinical factors to establish the optimum revascularization technique for individual patients with complex CAD. However, all previous studies [1][2][3][4][5] about the validation of the SS-II have enrolled patients totally or mostly treated with a first-generation DES and some even used a small number of bare metal stents. At present, secon...

Syntax Score I and II for Predicting Carotid Artery Stenosis in Patients with Multivessel Coronary Artery Disease: A Propensity Score Matching Analysis

“…SYNTAX score (SS) I and II are recent scores which are used for choosing the treatment modality in patients with multivessel disease. During the last decade, several studies showed a close association between these scores and cardiovascular outcomes [5-8] . The aim of our study is to determine the association between SS I-II and significant CAS in patients with multivessel disease undergoing CABG.…”

Prognosis evaluation of universal acute coronary syndrome: the interplay between SYNTAX score and ApoB/ApoA1

“…Brkovic et al found that SYNTAX score was superior to GRACE risk score, TIMI blood flow grading score, PAMI score and ZWOLLE score in predicting MACE events and cardiovascular mortality [15]. He's and other studies showed that in the use of the second generation of drug-eluting stents (DES) for the treatment of left main lesion patients, SYNTAX II score is an independent predictor of long-term mortality and has better predictive value than SYNTAX score [16]. For our study, we focused on the prognostic value of different SYNTAX scores in universal ACS patients.…”

Prognosis Evaluation of Universal Acute Coronary Syndrome: The Interplay between SYNTAX Score and ApoB/ApoA1

“…Brkovic et al found that SYNTAX score was superior to GRACE risk score, TIMI blood flow grading score, PAMI score and ZWOLLE score in predicting MACE events and cardiovascular mortality [15]. He`s and other studies showed that in the use of the second generation of drugeluting stents (DES) for the treatment of left main lesion patients, SYNTAX II score is an independent predictor of long-term mortality and has better predictive value than SYNTAX score [16]. For our study, we focused on the prognostic value of different SYNTAX scores in universal ACS patients.…”