Proximal left anterior descending coronary artery stenosis should be considered when using the prognostic value of the residual SYNTAX score: Data from 10343 consecutive patients with long-term follow up in the real world.

Abstract

The purpose of this study was to assess the prognostic significance of the residual SYNTAX score (rSS) in a large-scale cohort of consecutive percutaneous coronary intervention (PCI) patients and to analyze whether residual proximal left anterior descending coronary artery (pLAD) lesions affect the prognosis of patients with same or similar rSS levels. The rSS, measured after PCI, has been assessed as an independent predictor of long-term clinical outcome and a tool for quantification of incomplete revascularization, and still needs to be validated in various PCI populations. When using rSS to determine an objective level of reasonable incomplete revascularization, it is currently undefined whether a pLAD lesion deserves more attention. The calculations of baseline SYNTAX scores (bSS) and rSS were performed in 10,343 consecutive patients undergoing PCI in Fuwai Hospital from January 2013 to December 2013. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause death, myocardial infarction (MI), and any revascularization. Secondary endpoints included the individual components of the MACE, cardiac death, and all-cause death/MI. MACE and cardiac death rates were significantly higher among patients with residual pLAD stenosis ≥70%. rSS and residual pLAD stenosis ≥70% were both strong independent predictors of MACE. Compared with rSS, rSS plus residual pLAD stenosis was superior in predicting 30-month MACE (P = .0016). rSS is a strong independent predictor of long-term adverse clinical outcomes. Residual pLAD lesions affect the prognosis of patients with same or similar rSS levels.