Impact of Residual SYNTAX Score and Its Derived Indexes on Clinical Outcomes after Percutaneous Coronary Intervention

Abstract

Background:Residual SYNTAX score (rSS) and its derived indexes including SYNTAX revascularization index (SRI) and clinical rSS had been developed to quantify and describe the extent of incomplete revascularization. This study was conducted to explore the utility of the three scores among real-world patients after percutaneous coronary intervention (PCI).Methods:From January 2013 to December 2013, patients underwent PCI treatment at Fuwai Hospital were included. The primary endpoints were all-cause death and major adverse cardiovascular and cerebrovascular events. The secondary endpoints were myocardial infarction, revascularization, stroke, and stent thrombosis. Kaplan-Meier methodology was used to determine the outcomes. Cox multivariable regression was to test the associations between scores and all-cause mortality.Results:A total of 10,344 patients were finally analyzed in this study. Kaplan-Meier survival analysis indicated that greater residual coronary lesions quantified by rSS and its derived indexes were associated with increased risk of adverse cardiovascular events. However, after multivariate analysis, only clinical rSS was an independent predictor of 2-year all-cause death (hazard ratio: 1.02, 95% confidence interval: 1.01–1.03, P < 0.01). By receiver operating characteristic (ROC) curve analysis, clinical rSS had superior predictability of 2-year all-cause death than rSS and SRI (area under ROC curve [AUC]: 0.59 vs. 0.56 vs. 0.56, all P < 0.01), whereas rSS was superior in predicting repeat revascularization than clinical rSS and SRI (AUC: 0.62 vs. 0.61 vs. 0.61; all P < 0.01). When comparing the predictive capability of rSS ≥8 with SRI <70%, their predictabilities were not significantly different.Conclusions:This study indicates that all three indexes (rSS, clinical rSS, and SRI) are able to risk-stratify patients and predict 2-year outcomes after PCI. However, their prognostic capabilities are different.

The Incremental Prognostic Value of the Clinical Residual SYNTAX Score for Patients With Chronic Renal Insufficiency Undergoing Percutaneous Coronary Intervention

“…Therefore, it is difficult for cardiologists to treat individuals with highly complex CAD and CRI. Furthermore, the current study demonstrated that patients with older age, increased clinical cardiac-kidney comorbidities and more anatomically complex disease, as quantified by CRSS, tended to have IR, corroborating previous reports (3,9). The RSS, which was first developed by Stone in a large cohort of acute coronary syndrome (ACS) cases, is considered an important tool for quantifying and risk-stratifying the degree and complexity of residual stenosis following PCI, with a strong independent predictive value for clinical outcomes (1).…”

“…Park and colleagues firstly described CRSS in patients included in a large, multicenter and all-comer PCI registry, and demonstrated that it has better predictive value for 1-year ACD and target lesion failure after PCI compared with RSS (3). Recently, Song and co-workers assessed the prognostic value of CRSS in a large-sample study examining real-world patients, and the results showed that CRSS has improved predictability of 2-year mortality than the anatomic RSS and SYNTAX revascularization index (9). However, few reports have investigated the predictive value of CRSS in CRI cases.…”

“…However, the absence of clinical parameters in RSS represents one of the limitations in its ability to precisely risk stratify individuals with complex coronary artery disease (CAD). Previous studies have shown the prognostic value of clinical residual SYNTAX score (CRSS), which is derived as a product of RSS and modified ACEF (ACEF CRCL ) score (3,9). However, no previous studies have assessed the predictive potential of CRSS in CRI cases.…”

Residual coronary artery tree description and lesion EvaluaTion (CatLet) score, clinical variables, and their associations with outcome predictions in patients with acute myocardial infarction

“…[ 9 10 11 ] The residual SYNTAX score, its derivative, reflecting the burden of residual coronary lesions after revascularization, was also a useful tool to quantify the incomplete revascularization and risk-stratify for CAD patients. [ 5 , 12 ] However, the major fallacy of the SYNTAX score is not accounting for the variability in the coronary anatomy, where the weighting assignment to each segment is nomenclature-based. [ 13 ] We have recently developed a new Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system.…”

Application of SYNTAX and its Derivative Scores in the Selection of Revascularization Strategies for Complex Coronary Heart Disease

“…To address these limitations, researchers conducted a 2-year follow-up study in 512 STEMI patients, proposed the Logistic Clinical SYNTAX score (LCSS) concept, and concluded that the LCSS has significant discrimination and acceptable calibration in predicting all-cause mortality [21] . Furthermore, it has been demonstrated through continuous improvement of SYNTAX-derived scores and subsequent studies that the clinical SYNTAX score has better predictive performance than the residual SYNTAX score for all-cause mortality 2 years after revascularization for complex CAD, whereas its predictive power for revascularization is the opposite [22] . Compared to the clinical SYNTAX score, the SYNTAX score Ⅱ demonstrated more accurate predictive performance in predicting all-cause mortality after complex CAD revascularization [18] .…”