Predictive Performance Of SYNTAX Score And Derived Scores In Patients With Three-vessel And/or Left Main Coronary Artery Disease After PCI

Background and objective:The SYNTAX score(SS) is an angiography-based tool which can numerically describe the extent and complexity of coronary artery disease. SYNTAX score and its derived scores are useful indices in predicting PCI outcome. In this study, we compared the predictive value of the SS and other derived scores in patients with three-vessel and/or left main coronary artery disease undergoing PCI in real world.MethodrA total of 472 patients with left main and three-vessel coronary artery disease who received PCI for the first time in our department from October 2012 to October 2013 were enrolled in this study. According to the result of coronary angiography, their SYNTAX score, residual SYNTAX score were calculated. Based on their clinical data, clinical SYNTAX score, logistic clinical SYNTAX score and clinical residual SYNTAX score were calculated. The primary end point was major adverse cardiac and cerebral events(MACCE). Cox proportional hazard regression analyses were performed to evaluate the independent risk factor of MACCE. Furthermore, receiver operator characteristic (ROC) curve was generated to compare the predictive ability of SYNTAX score and its derived scores.Results:The mean baseline SS was 23.64±7.94 and mean rSS was 10.02±7.20. Tertiles for SYNTAX score were defined as bSS≤22(n=217),23≤bSS≤32(n=195), bSS>32(n=60). Increasing bSS tertiles had increasing 20-month MACCE rates(9.7%, 13.3%, 28.3%, log-rank p<0.001). Multivariable analysis showed SYNTAX score and CSS were independent predictors of 20-month MACCE and all-cause death. AUC of bSS and cSS for 20-month MACCE were 0.622 and 0.599, for 20-month all-cause death 0.718 and 0.770, respectively. In addition, logistic clinical SYNTAX score was an independent predictor of all-cause death at 20-month follow up.Residual SS tertiles were defined as rSS=0 (n=24),0<rSS≤10.0(n=262), and rSS>10.0(n=186). Increasing rSS tertiles had increasing 20-month MACCE rates (4.2%、8.4%、22.0%, log-rank p<0.001). By multivariable analysis, rSS was a strong independent predictor of MACCE at 20 months (hazard ratio:1.071,95%CI: 1.039-1.104, p<0.001), with predictability of MACCE similar to bSS (AUC 0.650 vs 0.622, p=0.4918). The clinical rSS, calculated by multiplying the rSS to a new age, creatinine clearance, diabetes and ejection fraction score (age/ejection fraction+1 for diabetes and for each lOmL the creatinine clearance< 60 mL/min), was also associated with 20-month MACCE, with predictability similar to rSS (AUC 0.650 vs 0.662, p=0.6063).Conclusion:1. SYNTAX score is an independent predictors of 20-month MACCE and all-cause death in patients with three-vessel and/or left main coronary artery disease. CSS doesn’t improve the predictive accuracy of 20-month prognosis if compared with the SYNTAX score alone.2.Logistic clinical SYNTAX score is an independent predictor of all-cause death in patients with three-vessel and/or left main coronary artery disease at 20-month follow up.3.The rSS is a useful tool to quantify and risk-stratify the degree and complexity of residual coronary stenosis after PCI. Specifically, rSS>10.0 after PCI in patients with three-vessel and/or left main coronary artery disease is associated with a poor 20-month prognosis.4.The new clinical rSS is also a strong independent predictor of MACCE in patients with three-vessel and/or left main coronary artery disease.