Abstract 12766: Long Term Outcome of Patients With Complete Revascularization

Abstract

Introduction: Complete revascularization (CR) is considered as a goal for percutaneous coronary intervention (PCI). Previous studies have proved that achieving CR is beneficial compared to incomplete CR. However there has been no research about the long term outcome within CR patients. Hypothesis: The SS has predictive value in CR patients. Methods: From patients enrolled in the Efficacy of Xience/Promus versus Cypher in rEducing Late Loss after stENTing (EXCELLENT) registry, the SYNTAX score was checked before and after PCI. The primary clinical outcome was 3-year patient-oriented composite endpoint (POCE), which was a composite of all cause death, any myocardial infarction, and any revascularization. Secondary outcomes were the individual components of 3-year POCE and 3-year target lesion failure (TLF). For calculation of the clinical SS, the SS was multiplied with the value of the ‘Age, Creatinine, and Ejection Fraction’ score. Results: Among 5102 patients from the EXCELLENT registry, 2112 patients achieved CR by PCI. 3-year POCE was less common in CR patients (10.0% vs. 16.9%, p<0.001) and CR was an independent predictor of adverse outcomes (Hazard ratio (HR) 1.326, 95% Confidence Interval (CI) 1.108-1.587, p=0.002). Patients who achieved CR were divided into 3 groups, according to the pre-PCI SYNTAX score (SS); 1≤low-SS<6: 771 patients, 6≤mid-SS<10: 692 patients, and high-SS≥10: 649 patients. 3-year POCE increased significantly along with increasing baseline SS tertiles (7.5% vs. 8.4% vs. 14.8%, p<0.001) and secondary outcomes also showed similar tendency. Multivariate analysis showed that baseline SS was an independent predictor of 3-year POCE (HR 1.032, 95% CI 1.011-1.053, p=0.003 per SS point). The clinical SS was superior to baseline SS in predicting 3-year POCE (AUC: 0.595 vs. 0.649, p=0.008). In subgroup analysis, baseline SS was a predictor for POCE only in multi-vessel diseases (HR 1.027, 95% CI 1.001-1.054, p=0.042 per SS point). Conclusions: CR is an independent predictor of 3-year POCE in patients receiving PCI. However, even after CR is achieved to make the post-PCI SS zero, baseline SS still has predictive value of 3-year clinical outcomes. Moreover, the predictivity is was superior in multi-vessel diseases.