Predictive Ability of the SYNergy Between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery Score II for Long-term Mortality in Patients with Three-vessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention Treated with Second-generation Drug-eluting Stents

Abstract

Background:The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery Score II (SS-II) can well predict 4-year mortality in patients with complex coronary artery disease (CAD), and guide decision-making between coronary artery bypass graft surgery and percutaneous coronary intervention (PCI). However, there is lack of data regarding the utility of the SS-II in patients with three-vessel CAD undergoing PCI treated with second-generation drug-eluting stents (DES). The purpose of the present study was to evaluate the ability of the SS-II to predict long-term mortality in patients with three-vessel CAD undergoing PCI with second-generation DES.Methods:Totally, 573 consecutive patients with de novo three-vessel CAD who underwent PCI with second-generation DES were retrospectively studied. According to the tertiles of the SS-II, the patients were divided into three groups: The lowest SS-II tertile (SS-II ≤20), intermediate SS-II tertile (SS-II of 21–31), and the highest SS-II tertile (SS-II ≥32). The survival curves of the different groups were estimated by the Kaplan–Meier method. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the relationship between the SS-II and 5-year mortality. The performance of the SS-II with respect to predicting the rate of mortality was studied by calculating the area under the receiver operator characteristic (ROC) curve. The predictive ability of the SS-II for 5-year mortality was evaluated and compared with the SS alone.Results:The overall SS-II was 27.6 ± 9.0. Among patients in the lowest, intermediate and the highest SS-II tertiles, the 5-year rates of mortality were 1.6%, 3.2%, and 8.6%, respectively (P = 0.003); the cardiac mortality rates were 0.5%, 1.9%, and 5.2%, respectively (P = 0.014). By multivariable analysis, adjusting for the potential confounders, the SS-II was an independent predictor of 5-year mortality (hazard ratio: 2.45, 95% confidence interval: 1.38–4.36; P = 0.002). The SS-II demonstrated a higher predictive accuracy for 5-year mortality compared with the SS alone (the area under the ROC curve was 0.705 and 0.598, respectively).Conclusion:The SS-II is an independent predictor of 5-year mortality in patients with three-vessel CAD undergoing PCI treated with second-generation DES, and demonstrates a superior predictive ability over the SS alone.

Comparison of Long-term Outcomes in Patients with Premature Triple-vessel Coronary Disease Undergoing Three Different Treatment Strategies

“…Recent studies have shown that PCI is associated with a similar risk of death compared with CABG in patients with multivessel disease,[ 19 20 ] especially in patients with lower SYNTAX score. [ 21 22 ] However, these studies focused only on TVD patients, not PTVD patients. Our results showed that PCI was associated with equal long-term benefit compared with CABG for all-cause death and cardiac death.…”

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

“…For patients with multivessel coronary disease, percutaneous coronary intervention (PCI) frequently involves incomplete revascularization (IR) because of coronary anatomy complexity or coexisting serious clinical conditions. [ 1 2 3 ] The prognostic impact of IR after PCI had been inconsistent among studies,[ 4 5 6 7 ] and one potential explanation was due to the lack of consent definition of IR. [ 8 ]…”

Long-term Outcomes of Elective Percutaneous Coronary Interventions

“…He и соавт. [32], у пациентов, чьи показатели соответствуют низкому, среднему и высокому терцилям SYNTAX score II, 5-летняя смертность составляла 1,6; 3,2 и 8,6 % соответственно, сердечнососудистая смертность -0,5; 1,9 и 5,2 % соответственно. При многофакторном анализе SYNTAX score II был независимым предиктором 5-летней смертности (относительный риск 2,45 при 95 % ДИ от 1,38 до 4,36;…”