Abstract 9738: Use of the Syntax Score In Predicting Outcome After Unrestricted Use of 'limus' Stents

Abstract

Background The SYNTAX score (SS) and clinical SS (cSS) are widely used to assess coronary lesion complexity, and are useful indices in predicting outcomes after percutaneous coronary intervention. However, SS was derived from a study that exclusively used paclitaxel eluting stents, and its applicability to patients receiving ‘limus’ eluting stents is unclear. Thus, we investigated the validity of the SS and cSS in predicting clinical outcomes from a cohort where ‘limus’ stents were used unrestrictedly. We also compared the predictability of the scores in everolimus eluting stents (EES) versus sirolimus eluting stents (SES). Methods Patients were from the Efficacy of Xience/Promus versus Cypher in rEducing Late Loss after stenting (EXCELLENT) registry and the SS was evaluated at an independent angiographic core lab. The 1-year patient oriented composite endpoint (POCE) (all cause death, any myocardial infarction (MI), and any revascularization) and target lesion failure (TLF) (cardiac death, target vessel MI, and target lesion revascularization) were the major analysis endpoints. The area under the curve (AUC) of a receiver operating characteristic was used as the predictability of SS and cSS. Results Among 5102 patients (7003 lesions) enrolled, 3047 patients (4235 lesions) received EES and 2055 patients (2768 lesions) received SES. Tertiles for SS were defined as low SS<8, 8≤mid SS≤16, high SS>16. From the whole population, both POCE (4.2% vs. 7.7% vs. 12.2%, p<0.001) and TLF (1.6% vs. 2.4% vs. 4.5%, p<0.001) increased significantly along with increasing SS tertiles, and SS was an independent predictor of POCE and TLF in multivariate analysis (p<0.001 for all) The predictability of SS and cSS was similar for POCE (AUC: 0.635 vs. 0.629, for SS vs. cSS, p=0.599) but cSS was superior to SS in predicting TLF (AUC: 0.625 vs. 0.680, for SS vs. cSS, p=0.008). When stratified according to each stent, higher SS tertiles were significantly associated with increased risk of POCE and TLF in both EES and SES. Conclusion Both SS and cSS were applicable to unrestricted use of ‘limus’ stents to predict the risk of 1-year adverse clinical outcomes. The predictability of SS and cSS was similar for POCE but the inclusion of clinical variables improved predictability of the SS for TLF.