Abstract 18148: Clinical Risk Stratification is a Better Determinant of Long-Term Survival Following Multivessel PCI Compared to Anatomic Risk Stratification Using the SYNTAX-Score
Background: We have previously shown, that clinical risk stratification using the EUROScore predicts long-term survival after multivessel PCI (MV-PCI). The SYNTAX-Score representing an anatomic risk stratification (SYNTAX-Score) for patients (pts) undergoing MV-PCI has recently been proposed to also predict clinical outcome.
Methods: Long-term survival was assessed in 679 consecutive pts, who underwent PCI in at least two main vessels. Pts were treated between August 2000 and December 2005. EUROScore, STS-Score and SYNTAX-Score were calculated for all pts. Clinical long-term follow-up was available in 664 pts (98%), with a mean-follow up time of 2.4±1.6 years.
Results: 316 pts (47%) were treated for acute myocardial infarction (n=176 STEMI; n=140 NSTEMI). On average, 2.5±0.6 vessels were diseased. 50 pts (7%) underwent treatment for left main disease. The multivariable cox-regression-analysis confirmed an elevated logistic EUROScore (HR 1.6 per tertile, 95% CI 1.1–2.6, p=0.032), age (>60 years HR 1.8, 95% CI 1.0–3.1; p=0.045), severely reduced left ventricular ejection fraction (HR 2.7, 95% CI 1.7–4.2; p<0.001), elevated C-reactive protein (HR 1.7, 95% CI 1.1–2.6; p=0.018) and chronic renal failure (HR 2.7, 95% CI 1.5–4.9; p=0.001) as independent predictors of long-term overall mortality. In contrast, clinical risk stratification using the STS-Score (HR 1.3 per tertile, 95% CI 0.9–2.0; p=0.140) and anatomic risk stratification using the SYNTAX-Score (HR 1.0, 95% CI 0.8–1.4; p=0.805) did not independently predict survival. A further analysis, restricted to stable pts to eliminate the influence of emergency circumstances, corroborated the findings (per tertile: EUROScore HR 2.5, 95% CI 1.4–4.3, p=0.001; STS-Score HR 1.3, 95% CI 0.8–2.2, p=0.258; Syntax-Score HR 1.2, 95% CI 0.8–1.7, p=0.371).
Conclusions: The logistic EUROScore outperforms the SYNTAXScore and STS-Score in predicting long-term survival following MV-PCI. Thus, anatomic risk stratification using the SYNTAX-Score as a surrogate marker of coronary artery disease burden is insufficient to predict long-term mortality following MV-PCI in daily practice.
- © 2010 by American Heart Association, Inc.