Prediction of 1-year clinical outcomes using the SYNTAX score in patients with prior heart failure undergoing percutaneous coronary intervention: sub-analysis of the SHINANO registry

Masatoshi Minamisawa,Shinichiro Uchikawa,Hideki Kobayashi,Yusuke Miyashita,Jun Koyama,Hironobu Kimura ,Naoyuki Abe,Hiroshi Akanuma,Toshio Sato,Shinichi Aso,Eiichiro Mawatari,Noboru Watanabe,Takuya Maruyama,Masanori Kobayashi,Keisuke Senda,Takayuki Eisawa,Naoto Hashizume,Shoji Hotta,Soichiro Ebisawa,Atsushi Izawa,Yuichi Kamiyoshi,Hirohiko Motoki,Takashi Miura,Hiroyuki Nakajima,Takehiro Morita,Uichi Ikeda

doi:10.1007/s00380-016-0896-9

Abstract

Although coronary artery disease (CAD) is common in patients with heart failure (HF), little is known about the prognostic significance of coronary lesion complexity in patients with prior HF undergoing percutaneous coronary intervention (PCI). The aim of this study was to investigate whether the coronary Synergy between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery (SYNTAX) score could improve risk stratification in HF patients with CAD. Two hundred patients (mean age 73 ± 11 years, left ventricular ejection fraction 49 ± 15 %) with prior HF who underwent PCI were divided into two groups stratified by SYNTAX score (median value 12) and tracked prospectively for 1 year. The study endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, and hospitalization for worsening HF. Adverse events were observed in 39 patients (19.5 %). Patients with high SYNTAX scores (n = 100) showed worse prognoses than those with low scores (n = 100) (26.0 vs. 13.0 %, respectively, P = 0.021). In multivariate Cox-regression analysis, SYNTAX score ≥12 was significantly associated with MACE (hazard ratio: 1.99, 95 % confidence interval: 1.02–3.97; P = 0.045). In patients with prior HF and CAD, high SYNTAX scores predicted a high incidence of MACE. These results suggest that the SYNTAX score might be a useful parameter for improving risk stratification in these patients.

Highlights

Heart failure (HF) is a serious healthcare problem in today’s aging society
Low-density lipoprotein cholesterol, Estimated glomerular filtration rate (eGFR), and HbA1c levels were similar between the two groups, whereas levels of brain natriuretic peptide tended to be higher in patients with high SYNTAX scores than in those with low scores
Risk stratification using the SYNTAX score has been validated in patients with Coronary artery disease (CAD) [20, 21]; there have been no studies using the SYNTAX score for risk stratification in HF patients undergoing percutaneous coronary intervention (PCI)

Summary

Introduction

Heart failure (HF) is a serious healthcare problem in today’s aging society. Despite significant advances in the treatment of chronic HF, the disease tends to follow a progressive course with high mortality and morbidity rates [1,2,3]. Patients with HF are at significant risk for recurrent cardiovascular events such as death, myocardial infarction (MI), stroke, and hospitalization for worsening HF. The secondary prevention of cardiovascular events is invaluable for improving the prognostic outlook of HF patients. Coronary artery disease (CAD) has contributed to the increased prevalence of HF and is associated with cardiovascular events in patients with HF [4,5,6,7]. The prognostic significance of the SYNTAX score for risk stratification in HF patients is poorly understood. We hypothesized that the SYNTAX score would predict adverse cardiovascular events in patients with HF.

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Results

Conclusion