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

Abstract

Objective: To broaden the data supporting the use of the residual SYNTAX score (rSS) to define "reasonable" incomplete coronary revascularization (ICR) in order to improve the allocation of patients with severe coronary artery disease (CAD) to surgical/percutaneous revascularization and long-term clinical outcomes. Introduction: ICR is associated with a worse prognosis in patients with severe CAD, yet no consensus exists regarding its definition. Methods: We studied 148 consecutive patients with triple vessel/left main (3VD/LM) CVD treated by percutaneous coronary interventions (PCI). Clinical outcomes at 3 years were collected; the SS and rSS were calculated. We used various definitions of "reasonable" ICR:no post-PCI total occlusion, single vs. mutivessel residual post-PCI disease, and the rSS at a cutoff value determined according to ROC curve fitted for 3 years major adverse cardiovascular and cerebrovascular adverse events (MACCE) in order to determine which definition has the strongest correlation with long-term outcomes. Results: rSS 8 was associated with significant reductions in 3 year MACCE (19.4 vs. 51.1%, HR 5 3.62, P 5 0.014) Death/MI/ CVA (13.7 vs. 28.8%, HR 5 6.01, P 5 0.030) and repeat revascularization (8.6 vs. 28.9%, HR 5 3.44, P 5 0.033) using a Cox proportional hazard ratio model adjusted to baseline characteristics, whereas single vessel residual disease and absence of total occlusion were not. Conclusions: "Reasonable" ICR as determined by rSS carries better long-term prognosis in terms of clinical outcomes vs. more extensive residual coronary disease in patients with 3VD/LM coronary artery disease treated by PCI. The rSS may improve the allocation of coronary patients to the optimal mode of revascularization. V C 2015 Wiley Periodicals, Inc.

Comparison of long-term prognostic value of baseline SYNTAX and clinical SYNTAX scores in ST-segment elevation myocardial infarction patients with multivessel disease

“…It is a direct measure of incomplete revascularization and is correlated with adverse events especially in stable CAD patients [18,21]. In the literature, there is no study investigating the prognostic value of rSS in STEMI patients.…”

Impact of the residual SYNTAX score on clinical outcomes after percutaneous coronary intervention for patients with chronic renal insufficiency

“…Patients in our study were stratified according to the rSS after PCI. CR, defined as an rSS value of 0, was achieved in only 24.1% patients, this rate was obviously lower than that reported by other studies . CKD is a common comorbidity with cardiovascular diseases, and it increases mortality and morbidity .…”

“…The residual SYNTAX score (rSS), which was recently proposed as an objective, quantitative measure of the degree and complexity of residual stenosis after PCI, has been validated as an independent predictor of worse clinical outcomes after PCI in different population cohorts . However, no previous study assessed the utility of rSS for patients with chronic renal insufficiency (CRI).…”

Effect of coronary dominance on 2‐year outcomes after percutaneous coronary intervention in patients with acute coronary syndrome

“…How to improve the accuracy and specificity of SS became a major point in correlational research. Since the development of the SYNTAX score, several models have been developed to enhance its prognostic efficiency, including residual SS, clinical SS, and logistic clinical SS . Considering the higher mortality of LD patients, it may be reasonable to increase SS weighting factors in LD patients and to recommend CABG because of the difficulty in intervening.…”