Coronary Artery Disease
Usefulness of the Baseline Syntax Score to Predict 3-Year Outcome After Complete Revascularization by Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2016.06.024Get rights and content

Although we strive to achieve complete revascularization (CR) in those receiving percutaneous coronary intervention, it is uncertain which of these patients are at increased risk of clinical events. In this study, we aimed to investigate whether the baseline SYNTAX score (bSS) can predict adverse clinical events in patients receiving CR. From the Efficacy of Xience/Promus Versus Cypher in Reducing Late Loss After Stenting registry, the 3-year patient-oriented composite end point (POCE; all cause death, any myocardial infarction, and any revascularization) was compared according to bSS tertiles (1 ≤ low bSS < 6, 6 ≤ mid-bSS < 10, high bSS ≥ 10). Of the 5,088 patients, CR was achieved in 2,173 by percutaneous coronary intervention. The 3-year POCE increased significantly along with bSS tertile (7.3% vs 8.4% vs 14.8%, p <0.001). Multivariate analysis showed that, despite having the same residual SS of 0, the bSS was an independent predictor of 3-year POCE (hazard ratio 1.038, 95% confidence interval 1.018 to 1.058, p <0.001 per bSS point). In subgroup analysis, bSS was a predictor for 3-year POCE in multivessel diseases (hazard ratio 1.029, 95% confidence interval 1.004 to 1.054, p = 0.025 per bSS point), whereas in single-vessel diseases, the discriminative value of bSS was less significant. Also the clinical SYNTAX score, which added age, creatinine level, and ejection fraction to the bSS, was superior to the bSS in predicting 3-year POCE (area under the curve 0.595 vs 0.649, p = 0.008). In conclusion, the bSS was an independent predictor of long-term clinical outcomes in patients receiving CR, especially in those with multivessel coronary artery disease. Adding clinical factors to the bSS could increase the predictive power of clinical outcomes.

Section snippets

Methods

Extended description of study methods is presented in the online Supplementary Appendix.

The Efficacy of Xience/Promus Versus Cypher in Reducing Late Loss After Stenting (EXCELLENT) registry was a multicenter registry enrolling patients from 29 centers in Korea to compare the efficacy of everolimus-eluting stents (Xience/Promus) versus sirolimus-eluting stents (SES; Cypher) in all comers who underwent percutaneous coronary intervention (PCI) with unrestricted drug-eluting stent use.9 The study

Results

The all-comer EXCELLENT registry enrolled 5,159 patients, from which 71 patients (1.4%) had uninterpretable post-PCI angiographic images, leaving 5,088 patients (98.3%) with bSS and residual SS values. The SS was significantly reduced after PCI (13.6 ± 9.1 to 4.7 ± 6.5, p <0.05). CR was achieved in 2,173 patients (42.7%) and the bSS of these patients was 8.5 ± 6.3. Patients receiving CR were divided into approximate tertiles, according to bSS: 832 patients (38.3%) in low bSS (1 ≤ bSS < 6, mean:

Discussion

The present study investigated whether the bSS could predict future events in patients who achieved CR, which was defined as a residual SS = 0. To the best of our knowledge, this study is the first study to show evidence of the predictive value of the bSS in patients with CR. We found that although SS was reduced to 0 after PCI, the clinical outcomes were influenced by the bSS. The predictive value was applicable to not only target lesion-related outcomes but also to nontarget lesion-related

Disclosures

The authors have no conflicts of interest to disclose.

References (23)

Cited by (15)

  • Validating the Performance of 5 Risk Scores for Major Adverse Cardiac Events in Patients Who Achieved Complete Revascularization After Percutaneous Coronary Intervention

    2019, Canadian Journal of Cardiology
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    Additionally, in these patients, the performance of AS or MAS (both scores involve only 3 clinical variables) is unknown. In a previous study the authors attempted to examine whether SS and CSS could predict clinical outcomes in patients with CR and reported that these 2 scores were related to prognosis.25 The areas under the curve for SS and CSS with regard to 3-year MACE were 0.595 and 0.649, respectively.

  • SYNTAX Score and Pre- and Poststent Optical Coherence Tomography Findings in the Left Anterior Descending Coronary Artery in Patients With Stable Angina Pectoris

    2017, American Journal of Cardiology
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    However, our study represents group of patients with stable angina who are not referred for coronary artery bypass grafting, thus have lower SS. It should also be noted that SS values in our study are consistent with those reported in the previous studies.5,26 Third, our analysis also included patients with single vessel disease.

  • Prognostic Value of the Clinical SYNTAX Score on 2-Year Outcomes in Patients With Acute Coronary Syndrome Who Underwent Percutaneous Coronary Intervention

    2017, American Journal of Cardiology
    Citation Excerpt :

    Assessments of individual and population-based outcomes after PCI are extremely important in clinical practice. The SS is a scoring system based on the complexity and severity of coronary lesions and had been evaluated as an excellent prognostic tool for risk stratification in various clinical settings.5–7,14 Palmerini et al14 is the first to assess the SS for risk prediction in non–ST-segment elevation patients with ACS who underwent PCI and showed that the SS was a powerful independent predictor of adverse outcomes after PCI during 1-year follow-up.

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This study was supported by research grants from the Seoul National University Hospital (04-2012-0770 and 05-2016-0030).

See page 645 for disclosure information.

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