Abstract
Background: The residual SYNTAX score (RSS) is considered a powerful prognostic indicator for determining a reasonable revascularization strategy in patients undergoing percutaneous coronary intervention (PCI), but the absence of clinical parameters is one of the limitations of RSS, especially in the chronic renal insufficiency (CRI) comorbidity setting. The present work aimed to investigate the incremental prognostic value of clinical residual SYNTAX score (CRSS) compared with RSS in CRI cases after PCI.Methods: Totally 2,468 consecutive CRI cases who underwent PCI from January 2014 to September 2017 were included in this retrospective analysis. CRSS was obtained by multiplying RSS by the modified ACEF score. Individuals with CRSS >0 were considered to have incomplete revascularization and stratified by CRSS tertiles, the remaining cases constituted the complete revascularization (CR) group. The outcomes between these groups were compared.Results: At a median follow-up of 3 years, compared with CR group, individuals with CRSS >12 showed elevated rates of all clinical outcomes, and those with CRSS ≤ 12 showed similar all-cause and cardiac mortality rates. In multivariable analysis, CRSS was a powerful independent predictive factor of all clinical outcomes. The net reclassification improvement levels of CRSS over RSS for all-cause and cardiac mortality rates were 10.3% (p = 0.007) and 16.4% (p < 0.001), respectively. Compared with RSS, CRSS markedly ameliorated all-cause and cardiac mortality risk stratification.Conclusions: Compared with RSS, CRSS has incremental predictability for long-term all-cause and cardiac mortality in CRI cases following PCI.
Highlights
The residual SYNTAX score (RSS) is considered an independent predictive factor of adverse outcomes among individuals undergoing percutaneous coronary intervention (PCI), and might aid in assessing a rational degree of revascularization [1,2,3,4,5,6,7]
The net reclassification improvement levels of clinical residual SYNTAX score (CRSS) over RSS for all-cause and cardiac mortality rates were 10.3% (p = 0.007) and 16.4% (p < 0.001), respectively
Previous studies have shown the prognostic value of clinical residual SYNTAX score (CRSS), which is derived as a product of RSS and modified ACEF (ACEFCRCL) score [3, 9]
Summary
The residual SYNTAX score (RSS) is considered an independent predictive factor of adverse outcomes among individuals undergoing percutaneous coronary intervention (PCI), and might aid in assessing a rational degree of revascularization [1,2,3,4,5,6,7]. Our recent study demonstrated that RSS has stronger predictability than baseline SYNTAX score (SS) for unplanned revascularization (UR) and stroke, as well as major adverse cardiovascular and cerebrovascular events (MACCEs) in chronic renal insufficiency (CRI) cases undergoing PCI at the 3-year follow-up [8]. The residual SYNTAX score (RSS) is considered a powerful prognostic indicator for determining a reasonable revascularization strategy in patients undergoing percutaneous coronary intervention (PCI), but the absence of clinical parameters is one of the limitations of RSS, especially in the chronic renal insufficiency (CRI) comorbidity setting. The present work aimed to investigate the incremental prognostic value of clinical residual SYNTAX score (CRSS) compared with RSS in CRI cases after PCI
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