The Predictive Value Of The SYNTAX Score In Patients With PCI

Objectives: The purpose of the present study to investigate the abilityof SYNTAX score and Clinical SYNTAX score （CCS） to predict long-termclinical outcomes in patients with percutaneous coronary intervention.Background: The current studies have been demonstrated SYNTAX scorebe able to predict clinical outcomes in patients undergoing percutaneouscoronary intervention. Of note, the previous studies were limited the Highrisk population, which enrolling patients with complex lesions （LM and/or3-vessel diseases） with undergoing percutaneous coronary intervention andenrolling most of patients came from Euro-Americans. The ability ofSYNTAX score and Clinical SYNTAX score （CSS） to predict Long-termoutcomes in Asian population and Low or Moderate risk patientsundergoing PCI remains to establish, especially in Chinese patients.Methods: This is prospective, nonrandomized, single center, and clinicalstudy. This study enroll547patients with undergoing selective andemergency percutaneous coronary intervention, and calculate the SYNTAXscores, the CSS was calculated by multiplying the SYNTAX score tomodified ACEF score. The primary endpoint patient-oriented composite endpoint was, including all-cause death, target lesion failure（TLF, includingcardiac death, target-vessel restenosis, target-vessel driven myocardiuminfraction, ischemia-driven target lesion revascularization（TLR））; and thesecondary endpoint including major adverse cardiac and cerebrovascularevents(MACCE, repeat revascularization, myocardial infarction（MI）, stentthrombosis; hospitalization due to angina pectoris at the range270-450days follow up by telephone or hospital visit at9,12, and15months.Tertiles for SYNTAX score was defined SS_LOW≤8（n=177）,8＜SSMID＜18（n=177）,18≤SSHIGH（n=193）, CSS_LOW≤10（n=182）,10＜CSSMID≤19.5（n=184）,19.5＜CSSHIGH（n=182）, respectively. Result: At15monthsfollow up, all clinical outcomes including: the rate of POCE, TLF, repeatrevascularization, cardiac death/MI, and MACCE were all significantlyhigher in patients in SSHIGHcompared with SS_LOWat450days follow up.The rate of MACCE was highest among the patients with SXscoreHIGH（13.5%in the high,6.8%in the intermedian,0%in the low, p<0.0001）.After multivariable adjustment, the SXscore were identified as independentpredictor of POCE [1.092（1.062-1.122） p<0.0001]. The CSS remained asindependent predictor regarding all cause death at450days follow up[1.1016（1.002-1.031） p=0.024]. Similar result were observed in a subgroupof511（93.4%） patients except who involved LM, in other word, the resultof multivariate analysis shows that the SXsocre was identified asindependent predictor for MACCE [1.118（1.083-1.154）, P<0.0001] in low and moderate risk patients undergoing PCI. There was no significantdifference for stent thrombosis and all-cause mortality in any the SXscoretertiles. Conclusion: This study confirms the consistent ability of theSXscore to stratify risk for long-term clinical outcomes in all-comerspopulation with PCI receiving second-generation drug-eluting stents（DES）.Subgroup analysis shows that, except these patients with stenosis ofLM, the SXscore remained identified as independent predictor clinicaloutcomes in low and intermedian risk patients treated by PCI. The presentstudy indicates that the CSS has no superiority ability of predictinglong-term clinical outcomes in patients with PCI.