Abstract 17110: Prognostic Value of the Residual SYNTAX Score to Quantify Untreated Coronary Artery Disease After Coronary Artery Bypass Grafting
Background: It has been previously shown that incomplete revascularization (IR) after CABG is associated with a worse prognosis compared with complete revascularization (CR). However, formal quantification of the extent and complexity of residual atherosclerosis after CABG has not been performed. We sought to determine the extent and complexity of residual coronary stenoses following CABG and to evaluate its impact on major adverse cardiovascular events (MACE).
Methods and Results: The baseline SYNTAX score (bSS) from 1608 patients (mean age 68±6 years) undergoing CABG was determined. In addition, the SS after CABG was assessed, generating the residual SS (rSS). Patients with rSS >0 were defined as having IR and were stratified by rSS tertiles, and their outcomes were compared to the CR group. The bSS was 26.6±9.4, and after CABG the rSS was 3.2±1.8. Following CABG, 1157/1608 (71.9%) patients had rSS = 0 (CR), 209/1608 (12.9%) had rSS >0 but ≤2, 176/1608 (10.9%) had rSS >2 but ≤8, and 66/1608 (4.1%) patients had rSS >8. At baseline, there were no significant differences between patients belonging to IR or CR subgroups, and among IR tertiles. The 30-day and 1-year rates of MACE were significantly higher in the IR group compared with the CR group, especially those with higher rSS. By multivariable analysis, rSS was a strong independent predictor of MACE at 1 year (hazard ratio: 2.24, 95% confidence interval: 1.62 to 4.09, p=0.003).
Conclusions: This study showed that rSS is a useful tool to quantify and risk-stratify the degree and complexity of residual stenosis after CABG. In particular, rSS >8.0 after CABG is associated with a poor 30-day and 1-year prognosis. Further studies are needed to confirm these findings.
- © 2013 by American Heart Association, Inc.