Modified residual SYNTAX score and clinical outcomes in patients with multivessel disease undergoing percutaneous coronary intervention.

Abstract

We sought to determine a reasonable level of revascularisation using the modified residual SYNergy between percutaneous coronary intervention (PCI) with TAXus and cardiac surgery (SYNTAX) score in patients undergoing PCI. In 3,460 patients with multivessel disease receiving drug-eluting stents, residual SYNTAX score (rSS) was calculated for lesions with ≥50% diameter stenosis in vessels ≥1.5 mm after PCI. The "modified" rSS (mrSS) was determined by counting lesions with ≥70% diameter stenosis in vessels ≥2.5 mm only. Patients were categorised into the complete revascularisation (CR) group (rSS=0), the incomplete revascularisation (ICR) group (mrSS >0), or the reasonable ICR (R-ICR) group (rSS >0, but mrSS=0). After propensity matching, the R-ICR group (n=1,129) had a comparable risk of all-cause death (HR 0.80, 95% CI: 0.56-1.15, p=0.24) and a composite of all-cause death, myocardial infarction (MI), or repeat revascularisation (HR 0.91, 95% CI: 0.74-1.14, p=0.41) compared with the CR group (n=637) at three years. In separate propensity matching analyses, patients with R-ICR (n=1,280) had a lower risk of all-cause death (HR 0.73, 95% CI: 0.55-0.97, p=0.03) and a composite of all-cause death, MI, or repeat revascularisation (HR 0.68, 95% CI: 0.57-0.82, p<0.001) than those with ICR (n=837) at three years. Complete revascularisation of lesions with ≥70% diameter stenosis in vessels ≥2.5 mm is better than ICR, and is a reasonable goal for patients with multivessel disease.