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Modified residual SYNTAX score and clinical outcomes in patients with multivessel disease undergoing percutaneous coronary intervention.

Research paper by Taek Kyu TK Park, Joo-Yong JY Hahn, Jeong Hoon JH Yang, Young Bin YB Song, Seung-Hyuk SH Choi, Jin-Ho JH Choi, Sang Hoon SH Lee, Joonghyun J Ahn, Keumhee Cho KC Carriere, Hyeon-Cheol HC Gwon

Indexed on: 25 Jan '17Published on: 25 Jan '17Published in: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology



Abstract

We sought to determine reasonable level of revascularization using the modified residual Synergy Between percutaneous coronary intervention (PCI) with Taxus and Cardiac Surgery (SYNTAX) score in patients undergoing PCI.In 3,460 patients with multivessel disease receiving drug-eluting stents, residual SYNTAX score (rSS) was calculated for lesions with ≥50% diameter stenosis in vessels ≥1.5 mm after PCI. "Modified" rSS (mrSS) was determined by counting lesions with ≥70% diameter stenosis in vessels ≥2.5 mm only. Patients were categorized into the complete revascularization (CR) group (rSS=0), incomplete revascularization (ICR) group (mrSS>0), or reasonable ICR (R-ICR) group (rSS>0, but mrSS=0). After propensity matching, the R-ICR group (n=1,129) had comparable risk of all-cause death (HR:0.80, 95%CI:0.56-1.15, p=0.24) and a composite of all-cause death, myocardial infarction (MI), or repeat revascularization (HR:0.91, 95%CI:0.74-1.14, p=0.41) compared with the CR group (n=637) at 3 years. In separate propensity matching analyses, patients with R-ICR (n=1,280) had a lower risk of all-cause death (HR:0.73, 95%CI:0.55-0.97, p=0.03) and a composite of all-cause death, MI, or repeat revascularization (HR:0.68, 95%CI:0.57-0.82, p<0.001) than those with ICR (n=837) at 3 years.Complete revascularization of lesions with ≥70% diameter stenosis in vessels ≥2.5 mm is better than ICR, and is a reasonable goal for patients with multivessel disease.

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