Abstract 16823: The Effect of Residual Coronary Lesions After Percutaneous Coronary Intervention on Clinical Outcomes
Background The SYNTAX score (SS) is used to assess coronary complexity and predict clinical outcomes after percutaneous coronary intervention (PCI). Although the SS can be reduced by PCI, the effect of residual SS (rSS) by incomplete revascularization, has not been fully evaluated. We investigated the impact of residual coronary lesions after PCI on adverse clinical outcomes in ‘limus’ stents.
Methods The baseline SS and rSS was calculated in 5102 patients (3047 patients with Everolimus eluting stents (EES) and 2055 patients with Sirolimus eluting stents (SES)) from the Efficacy of Xience/Promus versus Cypher in rEducing Late Loss after stenting (EXCELLENT) registry, at an independent angiographic core lab. The clinical rSS was calculated using age, and left ventricular ejection fraction and creatinine clearance. The primary analysis endpoint was 1-year patient oriented composite endpoint (POCE) (all cause death, any myocardial infarction (MI), any revascularization) and secondary endpoints were the individual components of the POCE.
Results The mean baseline SS was 13.6±9.1 and the mean rSS was 4.7±6.5. Tertiles for rSS were defined as rSS=0 (42.6%), 0<rSS<7 (29.8%), rSS≥7 (27.3%). Old age, males, heavier weight, diabetes, hypertension, previous MI, diagnosis of acute coronary syndrome, regional wall movement abnormality were more common in the higher rSS tertile. The 1-year POCE was more common in higher rSS (5.2% vs. 8.1% vs. 12.4%, p<0.001) and rSS was an independent predictor for POCE (hazard ratio (HR): 1.044, 95% confidence interval (CI): 1.030-1.057, p<0.001 per point of rSS) in multivariate analysis. This trend was consistent in subgroup analysis of the EES and SES group. The clinical rSS, which combined rSS with clinical risk factors, had a mean of 9.95±20.73. Higher clinical rSS had higher rates of 1-year POCE and was an independent predictor of POCE (HR: 1.012, 95% CI: 1.008-1.012, p<0.001 per point of clinical rSS). The clinical rSS was similar to rSS in predictability of clinical outcomes (Area-under-curve: 0.610 vs. 0.607 for rSS vs. clinical rSS, p=0.634).
Conclusion The rSS and clinical rSS were valid tools to estimate the risk of 1-year adverse clinical outcomes in ‘limus’ stents. The predictability of rSS and clinical rSS were comparable.
- © 2012 by American Heart Association, Inc.