Abstract 18591: Anatomically- Versus Clinically-derived Risk Scores Have Markedly Differing Predictive Abilities Following PCI For Multivessel CAD: The “TLR Paradox”
Objectives: Risk scores for predicting events after PCI vary widely in their calculation, ranging from purely anatomical (SYNTAX risk score [SRS]) to purely clinical (ACEF, modified ACEF [ACEFmod], NCDR), while other scores combine both elements (Clinical SYNTAX score [CSS], New York State Risk Score [NYSRS]). We sought to clarify the utility of these scores for predicting clinical events in pts with triple vessel CAD undergoing PCI.
Methods: Patients with triple vessel and/or LM disease with 12 month follow-up were studied from our single center PCI registry. Exclusion criteria included STEMI presentation, prior revascularization and shock. Clinical events at 12 months were compared to baseline risk scores, based on score tertiles and area under the receiver operating characteristic curves (AUC).
Results: We identified 584 eligible patients (69.8±12.3yrs, 405 males). All scores were predictive of mortality, with the SRS being least predictive (AUC=0.66) (Figure). The most accurate scores for mortality were the CSS and ACEF (AUC=0.76 for both: p=0.019 and 0.08 vs. SRS, respectively). In contrast, the SRS and CSS were the only scores predictive of MI (both p<0.05). For TLR, while the SRS trended toward being positively predictive (p=0.075), several scores trended towards a negative association, which reached significance for the NCDR (p=0.045) (Figure). No score was particularly accurate for predicting MACE (death+MI+TLR), with AUCs ranging from 0.53 (NCDR) to 0.63 (SRS).
Conclusions: Competing factors influence mortality, MI and TLR after PCI. An increasing burden of comorbidities is associated with mortality, but a paradoxically reduced likelihood of TLR. On the other hand, anatomical complexity predicts MI. By combining these outcomes to predict MACE, all scores show reduced utility.
- © 2012 by American Heart Association, Inc.