Abstract 20884: The Impact of Baseline and Residual SYNTAX Score on Clinical Outcome After Percutaneous Coronary Intervention With Everolimus-Eluting Stents for Left Main or Triple Vessel Disease : Data From EXCELLENT (Efficacy of Xience/Promus versus Cypher to Reduce Late Loss After Stenting) Trial and Excellent-Prime (Efficacy and Safety of Xience in Coronary Arery Disease All-Comers After Stenting Using the PRIME Platform) Registry
Introduction: Current treatment strategy on the coronary revascularization of left main or triple vessel disease is based on the Synergy Between Percutaneous Coronary Intervention (PCI) With Taxus and Cardiac Surgery (SYNTAX) score (SS), which was developed with Taxus Express paclitaxel-eluting stent.
Hypothesis: The impact of SS on clinical outcome in patients with third-generation DES needs to be fully validated.
Methods: The baseline SS (BSS) and residual SS (RSS) were determined in 1,418 patients with left main or triple vessel disease treated with Xience stent from the EXCELLENT and EXCELLENT-prime multi-center registry. The primary endpoint was major cardiac adverse event (MACE), which was composite of cardiac death, target-vessel myocardial infarction (TVMI), and target lesion revascularization (TLR).
Results: Three-year MACE was stratified by the BSS (low: 0-22 (n=802), intermediate: 23-32 (n=421), high: >32 (n=195)) and the RSS (0 (n=198), >0-8 (n=543), >8 (n=677)). The mean BSS and RSS was 21.5±9.8 and 9.5±8.1. Baseline characteristics showed that risk factors such as presentation as acute coronary syndrome, low ejection fraction, high creatinine increased along with BSS. Patients with higher BSS showed increasing 3-year MACE rates (5.4% vs. 9.5% vs. 14.9%, p<0.001). Cardiac death (2.4% vs. 5.2% vs. 7.2%, p=0.002) and TLR (3.2% vs. 4.5% vs. 8.2%, p=0.009). After propensity score matching to adjust baseline imbalances (195 pairs), difference in MACE rate between high BSS and low-intermediate BSS was not significant (11.8% vs. 14.9%, p=0.371). Patients with RSS over 8 showed significantly higher MACE rate (RSS 0-8, 6.2% vs. RSS>8, 9.7%, p=0.014) while the difference in MACE between complete revascularization (RSS=0) and reasonable incomplete revascularization was not significant (7.6% vs. 5.7%, p=0.351). Cardiac death (2.5% vs. 2.2% vs. 5.6%, p=0.005) and TLR (5.6% vs. 3.9% vs. 4.3%, p=0.605) showed similar trend. Cox proportional multivariable hazard analysis showed higher RSS was one of the strongest predictor of 3-year MACE (HR 1.294, 95% CI 1.067-1.568, p=0.009).
Conclusions: The value of BSS and RSS for predicting clinical outcomes was still valid in patients with left main or triple vessel disease underwent PCI with Xience.
Author Disclosures: J. Han: None. J. Kang: None. H. Yang: None. K. Park: None. H. Kang: None. B. Koo: None. H. Kim: None.
- © 2016 by American Heart Association, Inc.