Validation and comparison of the long-term prognostic capability of the SYNTAX score-II among 1,528 consecutive patients who underwent left main percutaneous coronary intervention.

Abstract

OBJECTIVES:

This study sought to evaluate the long-term prognostic capacity of the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score II (SS-II) and compare it with other risk scores among patients undergoing left main percutaneous coronary intervention (LM-PCI).

BACKGROUND:

Recently, the SS-II was developed in an attempt to individualize and help the decision-making process between PCI and coronary artery bypass graft (CABG) surgery in the management of complex coronary artery disease (CAD). However, there is a paucity of data regarding the utility of SS-II in patients undergoing LM-PCI.

METHODS:

Data from 1,528 consecutive patients from a single center undergoing unprotected LM-PCI were prospectively collected. The SS-II and other scores were then derived using patients' baseline clinical characteristics. Patients were stratified according to tertiles of SS-II for PCI: SS-II ≤21 (n = 508), SS-II >21 and ≤28 (n = 480), and >28 (n = 540). Predictive capability for long-term mortality was compared between angiographic scores and scores combining both angiographic and clinical variables.

RESULTS:

At a mean follow-up of 4.4 years, mortality in the first, second, and third SS-II tertiles was 1.8%, 3.5%, and 9.4%, respectively (p < 0.0001). Multivariate analysis showed SS-II to be a strong independent predictor of mortality (hazard ratio: 1.76, 95% confidence interval: 1.10 to 2.82; p = 0.02) after LM-PCI. When compared with the angiographic SS, scores combining both clinical and angiographic variables, such as the SS-II, were superior in terms of long-term prognostication.

CONCLUSIONS:

Results of this large series of consecutive patients who underwent unprotected LM-PCI suggested that the SS-II has better long-term prognostic power in terms of mortality compared with the original purely angiographic SS.

• Authors: Bo Xu, Philippe Généreux, Yuejin Yang, Martin B Leon, Liang Xu, Shubin Qiao, Yongjian Wu, Hongbing Yan, Jilin Chen, Yelin Zhao, Yanyan Zhao, Tullio Palmerini, Gregg W Stone, Runlin Gao
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 7 Issue 10 Pg. 1128-37 (Oct 2014) ISSN: 1876-7605 [Electronic] United States
• PMID: 25240551 (Publication Type: Comparative Study, Journal Article, Validation Study)
• Copyright: Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• China
• Coronary Angiography
• Coronary Artery Disease (diagnostic imaging, mortality, physiopathology, therapy)
• Coronary Vessels (diagnostic imaging)
• Decision Support Techniques
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Percutaneous Coronary Intervention (adverse effects, mortality)
• Predictive Value of Tests
• Proportional Hazards Models
• Prospective Studies
• Reproducibility of Results
• Risk Factors
• Severity of Illness Index
• Time Factors
• Treatment Outcome