Impact of residual coronary lesions on outcomes of myocardial infarction patients with multi-vessel disease

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Abstract Background Interest grew in residual disease burden after percutaneous coronary intervention (PCI). The residual SYNTAX score (rSS) is a strong prognostic factor of coronary events and all-cause death in patients who underwent PCI. Its derivative, the SYNTAX Revascularisation Index (SRI), has been used in determining the proportion of coronary artery disease (CAD) that has been treated and has been shown to have prognostic utility in PCI for patients with multi-vessel disease (MVD). Purpose We sought to assess the use of the rSS and the SRI as predictors for in-hospital outcomes and up to two-year follow-up outcomes in patients with MVD who underwent PCI in the setting of ST-Elevation Myocardial Infarction (STEMI) or Non-STEMI (NSTEMI). Methods We recruited 149 patients with either STEMI or NSTEMI in the setting of MVD who underwent PCI. We divided them into tertiles, based on their rSS and SRI values, respectively. We calculated bSS and rSS using the latest version of the web-based calculator, and from these scores we calculated SRI. The endpoints were: In-hospital composite MACE and its components, in-hospital mortality, follow-up MACE, and follow-up all-cause mortality up to 2-years. Results RSS and SRI were not significant predictors of in-hospital death or MACE, while hypertension, ST-segment resolution, LVEF, and significant left main coronary artery (LMCA) lesions were independent predictors of in-hospital MACE. At two-year follow-up, Kaplan-Meier analysis showed significantly increased incidence of death and MACE within the third rSS tertile (rSS >12) compared to the other tertiles (log rank p<0.001), while there was no significant difference between the three SRI tertiles. RSS and SRI were predictors of death and MACE on univariate Cox regression analysis. On multivariate Cox regression, rSS was an independent predictor for MACE (HR=1.0696, 95% CI: 1.0147–1.1275, p=0.0123) and all-cause mortality (HR=1.1114, 95% CI: 1.0430–1.1842, p=0.0011). Of notice, all patients with complete revascularisation survived throughout the entire follow-up period. Conclusions The rSS and SRI were poor predictors of in-hospital death and MACE, while they were good predictors of death and MACE at two-year follow-up, with better overall performance for rSS in comparison to SRI. Patients with rSS values >12 showed significantly higher incidence of MACE and all-cause mortality at two years. The best prognosis was achieved with complete revascularisation. Funding Acknowledgement Type of funding sources: None.