Abstract
Background
Previous studies reported conflicting results regarding the impact of incomplete revascularization on the outcome of percutaneous coronary intervention (PCI). We evaluated the association between residual SYNTAX score (RSS) as a quantitative measure of incomplete revascularization and one-year outcome of patients with native multi-vessel disease undergoing PCI.
Methods
A total of 760 patients (mean age = 59.14 ± 10.36 years, 70.4% males) who underwent successful PCI with the incomplete revascularization strategy between September 2008 and March 2010 were included. The RSS was used to quantify the extent and complexity of residual coronary stenosis following PCI. Multivariable analysis was used to evaluate the impact of RSS on one-year major adverse cardiac events (MACE) including death, myocardial infarction, and revascularization.
Results
Overall incidence of one-year MACE was 4.74%. Using ROC curve analysis a cut-off of > 5 for baseline RSS had a significant association with occurrence of 12-month MACE (area under the curve = 0.769; P value < 0.001, sensitivity = 75% and specificity = 72%). Unadjusted effect of RSS > 5 on 12 months MACE showed a hazard ratio of 7.34 (p value < 0.001). By multivariable analysis, effect of the RSS > 5 on 12 months MACE was adjusted for potential confounders. After adjustment to clinical SYNTAX score as the sole confounder, RSS > 5 remained a strong associate with 12 months MACE and its effect outweighed that of before adjustment (hazard ratio = 8.03, p value < 0.001).
Conclusions
The RSS is a quantified measure of the complexity of residual coronary stenoses, and RSS > 5 could be able to discriminate patients with an increased risk of one-year MACE.
Highlights
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We evaluated the prognostic value of the residual SYNTAX score (RSS) as a quantitative measure of incomplete revascularization in the prediction of the one-year outcome of patients with native multi-vessel disease.
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A total of 760 patients who underwent successful PCI with the incomplete revascularization strategy were included. The RSS was used to quantify the extent and complexity of residual coronary stenosis following PCI. Multivariable analysis was used to evaluate the impact of RSS on one-year major adverse cardiac events (MACE) including death, myocardial infarction, and revascularization.
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Overall incidence of one-year MACE was 4.74%. Using ROC curve analysis a cut-off of > 5 for baseline RSS had a significant association with occurrence of 12-month MACE (area under the curve = 0.769; P value < 0.001, sensitivity = 75% and specificity = 72%).
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The RSS as a quantified measure of the complexity of residual coronary stenoses has a good discriminatory power for the risk prediction of one-year outcomes of PCI.
1
Introduction
The optimal PCI strategy in multi-vessel disease patients continues to be a matter of controversy. Previous studies have reported conflicting results regarding the prognostic impact of incomplete revascularization on the outcome of PCI . There are possible reasons for this incongruity. Firstly, it seems to be due to the lack of a universally accepted definition for incomplete revascularization. That is to say, the definitions of incomplete revascularization in previous studies varied according to the stenosis severity, vessel size diameter and nature of residual coronary stenosis after PCI, all of which can influence the outcome . The second reason is that these studies evaluated the impact of incomplete revascularization in different clinical settings such as acute coronary syndrome and unprotected left main coronary artery PCI . Such incongruities underscore the need for a systematic characterization and quantification of residual atherosclerosis following PCI to augment the prognostic utility of incomplete revascularization. The residual SYNTAX score (RSS) has been recently introduced for patients with acute coronary syndrome . The RSS could be calculated after PCI to provide an objective and potentially useful quantification of incomplete revascularization.
The aim of the present study was to evaluate the prognostic value and the acceptable cut-off of the RSS as a quantitative measure of incomplete revascularization in the prediction of the one-year outcome of patients with native multi-vessel disease undergoing PCI in a real-world practice.
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