Abstract 13904: The SYNTAX Score Predicts Major Bleeding after Drug-Eluting Stent implantation in the All-Comers population
Purpose: The bleeding complication has been one of frequent complications in the drug-eluting stent (DES) era. Previous study reported that percutaneous coronary intervention (PCI) in complex lesion is an independent correlate of major bleeding. This finding may be explained by more complicated procedure and longer dual anti-platelet therapy. The SYNTAX score is a current angiographic tool grading the complexity of coronary artery disease. The aim of this study was to assess the ability of the SYNTAX score to predict major bleeding after DES implantation.
Methods: We analyzed a consecutive 560 patients treated with DES in the all-comers population between January 2007 and January 2009. Endpoints were analyzed for major bleeding (defined according to the REPLACE-2 trial) and late stent thrombosis during 3 years. The SYNTAX score was assessed with angiogram before PCI by 2 cardiologists. Patients were stratified according to tertiles of the SYNTAX score: low score (0-12, n=170), intermediate score (13-24, n=202), and high score (≥25, n=188).
Results: Incidence of the major bleeding was seen in 49 patients (8.8%) during 3 years. There were 15 stent thrombosis (2.7%). The median SYNTAX score was 17 (range 0 to 75.5). Among patients in the low, intermediate, and high scores, the 3-year rate of major bleeding were 4.7%, 5.0%, and 16.5%, respectively (p<0.0001). On univariate analysis, the SYNTAX score showed a strong association (for each 10-unit increase in SYNTAX score, Odds ratio1.69, 95% confidence interval 1.39-2.06, p<0.0001). Multivariate logistic regression including clinical factors showed in the table.
Conclusions: In the all-comers population undergoing DES implantation, the SYNTAX score has a predictive ability for patients at risk of major bleeding. The score may be useful for clinical decision making regarding optimal duration of dual anti-platelet therapy after DES.
- © 2012 by American Heart Association, Inc.