Relationship Between Residual SYNTAX Score And Long-term Prognosis In Diabetic Patients Undergoing Percutaneous Coronary Intervention

Objective:As an effective tool to evaluate the degree of revascularization,residual SYNTAX score(rSS)is closely related to the prognosis of patients after percutaneous coronary intervention(PCI).At present,there is little research on the relationship between rSS and long-term prognosis in Chinese diabetic patients after PCI.There is no consistent view on the threshold of appropriate revascularization in diabetic.The exist evidence is mostly from the study of some specific populations or subgroup analysis of small samples.Therefore,The prognosis impact of rSS on long-term outcome in diabetic patients after PCI was analyzed in this study,and the appropriate revascularization threshold of diabetic patients in China was further explored in order to provide reference for clinical decision-making.Methods:According to inclusion and exclusion criteria,patients complicated with diabetes mellitus received PCI from Department of Cardiology,Third People’s Hospital of Chengdu from July 2018 to December 2020 were consecutively included in the study.Professionals would inquired and recorded the occurrence of all-cause death,cardiogenic death,recurrent myocardial infarction after discharge.The composite endpoint of all-cause death,recurrent myocardial infarction and unplanned revascularization was defined as the primary endpoint(MACE).Patients were categorized into three groups according to rSS:complete revascularization(CR)group(group A,rSS=0);reasonable incomplete revascularization(rICR)group(group B,0<rSS<8)and incomplete revascularization(ICR)group(Group C,rSS≥ 8).The differences of general baseline data,clinical complications,laboratory examination results,discharge medication,coronary lesions and long-term prognosis among the three groups were compared.The linear regression model and the scatter diagram were carried out to analyze the relationship between bSS and rSS.Survival curves of composite events of MACE,all-cause death and unplanned revascularization was draw,respectively.Log-rank test was used for comparison between groups.Multivariate Cox analysis was conducted to screen the risk factors of composite events of MACE in diabetic after PCI,further,the receiver operating curve(ROC)was drawn to evaluate the predictive value of rSS for long-term prognosis.Results:A total of 633 diabetic patients underwent PCI were enrolled in this study.Among them,425 were male(67.1%)and 208 were female(32.9%).There were 161 cases(25.4%)in CR group(group A),278 cases(43.9%)in rICR group(group B)and 194 cases(30.6%)in ICR group(Group C).The median follow-up time was 18.83(14.55,22.88)months.During the follow-up period,99 cases(15.6%)of composite events of MACE,35 cases(5.5%)of all cause death,21 cases(3.3%)of cardiac death,20 cases(3.1%)of recurrent myocardial infarction,64 cases(10.1%)of unplanned revascularization and 22 cases(3.4%)of stroke occurred,respectively.(1)Baseline data comparisonThe average age of patients in group C(69.81 ± 10.1)was older than that in group A and group B(P<0.05).The degree of coronary anatomical lesion in group C was more complex.The bSS of group B and C were higher than those of group A.At the same time,the bSS of group C were higher than those of group B(all P<0.01).Linear regression model showed that there was a strong linear relationship between bSS and rSS(r=0.549,95%Cl 0.49-0.608,P<0.001).With the increase of bSS,rSS showed an increasing trend.(2)Comparison of adverse cardiovascular events in each groupThe incidence of composite events of MACE(28.4%vs 6.8%vs 11.9%),all-cause death(10.3%vs 1.9%vs 4.3%),cardiac death(6.7%vs 1.2%vs 2.2%),recurrent myocardial infarction(7.7%vs 1.2%vs 1.1%)and unplanned revascularization(18.0%vs 5.0%vs 7.6%)in group C were significantly higher than those in group A and B(P<0.05).The incidence of long-term composite events of MACE(6.8%vs 11.9%),all-cause death(1.9%vs 4.3%),cardiac death(1.2%vs 2.2%),recurrent myocardial infarction(1.2%vs 1.1%)and unplanned revascularization(5.0%vs 7.6%)were similar between group A and B(P>0.05).Survival analysis indicated the cumulative incidence of composite endpoint of MACE(χ2 value=44.78,P<0.01),all-cause death(χ2 value=16.44,P<0.01)and ischemic driven unplanned revascularization(χ2 value=28.35,P<0.01)in group C were higher than those in groups A and B.(3)Cox multivariate regression analysis of composite events of MACEMultivariate Cox regression analysis showed that age[HR 1.0233,95%CI(1.0035-1.0434),P=0.0208],serum creatinine[HR 1.0011,95%CI(1.00011.0021),P=0.0390]and rSS[HR 1.0513,95%CI(1.0186-1.0850),P=0.0019]was independent risk factor for composite events of MACE after PCI in diabetic patients,LVEF[HR 0.9764,95%CI(0.9571 0.996),P=0.0188]was protective factor of the occurrence of composite events of MACE.(4)Significance of rSS in predicting long-term prognosisROC curve analysis showed that rSS had predictive value for composite events of MACE,all-cause death and unplanned revascularization in diabetic patients after PCI.The area under the ROC curve(AUC)(95%CI)was 0.673(0.635,0.710),0.650(0.611,0.687),0.665(0.627,0.702),respectively.The sensitivity was 0.556,0.60 and 0.469,the specificity was 0.745,0.716 and 0.810,and the cut-off values were 7.5,7.5 and 9,respectively.Conclusion:rSS is an independent risk factor for long-term cardiovascular adverse events in diabetic after PCI,independent of bSS and other clinical factors.It has a certain predictive value for composite events of MACE,all-cause deaths and unplanned revascularization.For diabetic patients complicated with multivessel disease,if the anatomy lesion is too complex to achieve complete revascularization by PCI,partial revascularization guided by the rSS seems a reasonable choice.rSS<8 may be the appropriate revascularization threshold for diabetic patients..