Abstract 4338: SYNTAX Score Predicts Major Adverse Cardiovascular and Cerebrovascular Event (MACCE)-free Survival, but Not Overall Survival, in Unprotected Left Main Coronary Artery (ULMCA) Patients Undergoing Percutaneous Coronary Revascularization (PCI): 3-Year Follow-up Analysis
Background The outcomes of unprotected left main coronary artery (ULMCA) revascularization depend on lesion complexity and comorbidities. We studied the impact of Parsonnet score (PS) and SYNTAX score (STX) on outcomes after ULMCA PCI and CABG.
Methods STX and PS were calculated in 328 ULMCA patients [120 PCI (f/u 973 days), 208 CABG (f/u 1298 days)]. Outcomes were compared by STX quartiles and lesion complexity using propensity score. The ability of STX to independently predict outcomes was assessed by Cox method.
Results Median STX was 26 in PCI and 28 in CABG group (p=0.5). In PCI group, high quartiles were associated with poorer survival [62.1% (STX >=36) vs 82.4% (STX <36), p=.03] and MACCE-free survival [47.7% (STX >= 20) vs 76.6% (STX <20), p=.02, Fig 1a⇓]; however STX did not predict outcomes in the CABG group. Isolated ULMCA PCI patients (STX <13) had better MACCE-free survival than those with complex lesions (STX >=13, p=.01, Fig 1b⇓). After adjusting for propensity score, PCI had higher MACCE rates than CABG for complex lesions (STX 13–25 Hazard ratio (HR) 2.34, p=.03; STX >25 HR 2.61, p=.003); however survival was similar between the two groups, regardless of lesion complexity. Using PS as a covariate, STX continued to be an independent predictor of MACCE (HR 1.02, p=.04) for PCI; although it did not predict survival independently.
Conclusions Both coronary anatomy (STX) and comorbidities (PS) predict long term outcomes of ULMCA PCI. After adjusting for comorbidities, STX continues to be an independent predictor of MACCE; however it fails to predict survival independently. Thus, comorbidities play a more important role than coronary anatomy in determining survival of ULMCA PCI.