The Value Of SYNTAX Score On The Prognosis Of Patients Undergoing Percutaneous Coronary Intervention

Part one SYNTAX Score and SYNTAX score Ⅱ Predict One-Year Outcomes in Patients Who Underwent Percutaneous Coronary Intervention Procedure[Objective]To investigate the prognosis of SYTNAX Score and SYNTAX score Ⅱfor 1-year incidence of adverse clinical events following PCI.[Methods]PANDA Ⅲ was a perspective,multi-center,"all-comer",randomized controlled trial.Between Dec.2013 and Sep.2014,2348 patients from 46 centers were enrolled.All patients were divided into 3 groups based on SYNTAX Score:lower risk group(SYNTAX Score≤ 22,1777 patients),intermediate risk group(22<SYNTAX Score≤ 32,412 patients)and higher risk group(>32,159 patients).Among the 2348 patients,723 patients with left main and/or three-vessel disease were enrolled.The SYNTAX score and SYNTAX-II score were calculated in this group,and the subjects were divided into three groups according to the tertile.There were 241 patients in lower risk group(SYNTAX Score≤15),254 patients in intermediate risk group(15<SYNTAX Score≤ 24)and 228 patients in higher risk group(SYNTAX Score>24).SYNTAX-Ⅱ scores 0 to 23 were lower risk group(224 patients),24-31 were intermediate risk group(255 patients),32 points and above were higher risk group(244 patients).Stratified analysis was performed according to different groups.Primary endpoint was target lesion failure(TLF),including cardiac death,target vessel myocardial infarction and ischemia driven target lesion revascularization.Secondary endpoints included stent thrombosis and major adverse cardiac events(MACE),defined as a composite of death,myocardial infarction and any revascularization.[Results]A total of 1766(99.2%),411(99.8%)and 159(100%)patients in the lower risk group,intermediate risk and higher risk group completed 1-year follow-up,respectively.Incidence of TLF in the 3 groups were:lower risk group:5.62%(99/1763),intermediate risk group:8.76%(36/411),higher risk group:8.81%(14/159),with significant difference(p=0.03).MACE rate were 8.05%in lower-risk group,11.68%in intermediate risk group,and 14.47%in higher risk group(p=0.004).A total of 723 patients with left main and/or three-vessel disease were enrolled.There were no statistical difference(p=0.33)among the incidence of TLF events in the lower,intermediate and higher SYNTAX scores[7.95%(19/239),10.67%(27/253),7.02%(16/228),respectively].Meanwhile,there were no statistical significance(p=0.26)among the incidence of MACE in the lower risk,intermediate risk and higher risk group were 12.55%(30/239),16.60%(42/253)and 11.84%(27/228)respectively.However,there were significantly statistical differences among the incidence of TLF in the 3 groups of the SYNTAX-Ⅱ score[5.38%(12/223),8.30%(21/253),and 12.30%,respectively,p=0.03].Yet,there were no statistic differences among the incidence of MACE in the 3 groups of the SYNTAX-Ⅱ score[12.11%(27/223),13.83%(35/253),17.62%(43/244),respectively,p=0.22].Multivariable analysis showed that age,total stent length and baseline SYTNAX Score are risk factors for TLF in all patients.Multivariate analysis of left main and/or triple-vessel disease showed that age,left ventricular ejection fraction,creatinine clearance,and SYNTAX-Ⅱ are the risk factors for all-cause mortality;and age,SYNTAX-Ⅱ score were the independent predictors for TLF(P<0.05).The predicted value of the SYNTAX-Ⅱ score for all cause death is higher than the SYNTAX score(AUC 0.72 vs.0.59,p=0.001).[Conclusions]1.The SYNTAX score is a valuable tool for predicting prognosis following PCI in coronary artery disease patients.2.The SYNTAX score has predictive value for the long-term prognosis not only in the left main and/or triple-vessel disease populations,but also in the entire population.3.The SYNTAX-Ⅱ score is more predictive than the SYNTAX score in the patients with left main and/or triple-vessel disease.Part two Long-term Prognostic Value of SYNTAX Score in Patients with Single or Two-vessel Disease Underwent Percutaneous Coronary Intervention[Objective]To investigate the prognostic value of SYTNAX Score for 1-year adverse clinical events following PCI in patients with single or two-vessel disease.[Methods]PANDA III was a perspective,multi-center,"all-comer",randomized controlled trial.Between Dec.2013 and Sep.2014,2348 patients from 46 centers were enrolled.We prospectively calculated SYNTAX Score for all the patients.There are a total of 1663 patient with single or two-vessel disease were included in the present study.Patients were divided into 3 groups based on SYNTAX Score:lower risk group(SYNTAX Score≤ 22,1388 patients),intermediate risk group(22<SYNTAX Score≤32,212 patients)and higher risk group(>32,63 patients).The primary endpoint was major adverse cardiac events(MACE),defined as a composite of death,myocardial infarction and any revascularization.The secondary endpoint included stent thrombosis and target lesion failure(TLF),defined as a composite of cardiac death,target vessel myocardial infarction and ischemia driven target lesion revascularization.[Results]A total of 1378(99.27%),211(99.53%)and 63(100%)patients in the lower risk group,intermediate risk and higher risk group completed 1-years follow-up,respectively.There were significantly statistical differences among the incidence of MACE in the lower risk,intermediate risk and higher risk group[6.31%(87/1378),10.90%(23/211)and 20.63%(13/63),respectively,p<0.0001].The differences were mainly driven by significantly higher incidence of all-cause death and myocardial infarction.Incidence of all-cause death in the high to intermediate risk group is significantly higher than in the lower risk group[11.11%(7/63),1.42%(3/211),1.45%(20/1378),respectively,p<0.0001].The incidence of 1-year myocardial infarction was positive correlated with SYTNAX Score[the incidence in the lower,intermediate and higher risk group were 3.63%(50/1378),7.58%(16/211),14.29%(9/63),respectively,p=0.0002].Incidence of TLF in the 3 groups were also significantly different[4.57%(63/1378),9.95%(21/211)and 12.70%(8/63),respectively,p=0.0005].Compared with lower and intermediate risk group,the higher risk group had higher incidence of target vessel myocardial infarction[3.27%(45/1378),7.58%(16/211)andl2.70%(8/63),respectively,p=0.0001].Multivariable analysis showed that age,gender and baseline SYTNAX Score are risk factors for MACE.[Conclusions]The SYNTAX score is a strong independent predictor of MACE and a valuable tool for predicting prognosis following PCI in patients with single and two-vessel coronary artery disease.