Abstract 15992: Risk Stratification Following Complex PCI: Anatomic Vs. Clinical Risk Stratification Compared with the “Post PCI Residual Syntax-score” as Quantification of Incomplete Revascularization
Background: We have previously shown, that clinical risk stratification using the EuroSCORE and completeness of revascularization predicts long-term survival after multivessel PCI (MV-PCI). The SYNTAX-Score also been proposed to also predict clinical outcome.
Methods/Results: Long-term survival was assessed in 740 consecutive patients, who underwent multivessel PCI. EuroSCORE, SYNTAX-Score and the STS-Score were calculated. In addition the “post-PCI residual Syntax-SCORE” was calculated to quantify incompleteness of revascularization. Follow-up was available in 726 patients (mean-follow up time 4.5±2.5 years). 341 pts (46%) were treated for an acute coronary syndrome (STEMI N=191; NSTEMI N=150) whereas 399 patients underwent MV-PCI for stable CAD. 113 pts (15%) underwent PCI of left main coronary artery. As expected, the average EuroSCORE was significantly lower for stable patients compared to patients with ACS (stable 4.1±4.5, NSTEMI 13.9±13.3, STEMI 18.1±18.7, p<0.001). The differences in the SYNTAX Score were less pronounced but even significant (stable 14.9±8.6, NSTEMI 17.8±9.9, STEMI 18.3±9.0; p<0.001). Patients in the highest tertiles of these scores experienced a dramatically elevated mortality rate compared to the extremely low mortality rate in the lower tertiles (p log-rank < 0.001). This comparison remained significant for the EuroSCORE and the STS-Score but not for the SYNTAX-Score (p=0.889), when analysis was restricted to stable patients. In addition the multivariable Cox-regression-analysis of the stable patients confirmed the logistic EuroSCORE (HR per point 1.10, 95%CI 1.06-1.14) and the STS-Score (HR per point 1.11; 95% CI 1.04-1.20) as independent predictors of long-term mortality, whereas the SYNTAX-Score had no predictive value (HR per point 0.99, 95%CI 0.96-1.02). However the residual SYNTAX score was independent predictive for long-term survival (>0: HR 1.74; 95% CI 1.02-2.97).
Conclusion: The logistic EuroSCORE and the STS-Score outperforms the SYNTAX-Score in predicting long-term survival following MV-PCI. The “post-PCI residual SYNTAX-Score” as quantified incompleteness of revascularization predicts long-term survival and emphasizes the importance of complete revascularization.
- © 2012 by American Heart Association, Inc.