Modified residual SYNTAX score and clinical outcomes in patients with multivessel disease undergoing percutaneous coronary intervention

Abstract

Aims: We sought to determine a reasonable level of revascularisation using the modified residual SYNergy between percutaneous coronary intervention (PCI) with TAXus and cardiac surgery (SYNTAX) score in patients undergoing PCI. Methods and results: In 3,460 patients with multivessel disease receiving drug-eluting stents, residual SYNTAX score (rSS) was calculated for lesions with >50% diameter stenosis in vessels >1.5 mm after PCI. The "modified" rSS (mrSS) was determined by counting lesions with >70% diameter stenosis in vessels >2.5 mm only. Patients were categorised into the complete revascularisation (CR) group (rSS=0), the incomplete revascularisation (ICR) group (mrSS >0), or the reasonable ICR (R-ICR) group (rSS >0, but mrSS=0). After propensity matching, the R-ICR group (n=1,129) had a comparable risk of all-cause death (HR 0.80, 95% CI: 0.56-1.15, p=0.24) and a composite of all-cause death, myocardial infarction (MI), or repeat revascularisation (HR 0.91, 95% CI: 0.74-1.14, p=0.41) compared with the CR group (n=637) at three years. In separate propensity matching analyses, patients with R-ICR (n=1,280) had a lower risk of all-cause death (HR 0.73, 95% CI: 0.55-0.97, p=0.03) and a composite of all-cause death, MI, or repeat revascularisation (HR 0.68, 95% CI: 0.57-0.82, p<0.001) than those with ICR (n=837) at three years. Conclusions: Complete revascularisation of lesions with >70% diameter stenosis in vessels 22.5 mm is better than ICR, and is a reasonable goal for patients with multivessel disease.