Korean Circ J.  2020 Jan;50(1):22-34. 10.4070/kcj.2019.0097.

SYNTAX Score and SYNTAX Score II Can Predict the Clinical Outcomes of Patients with Left Main and/or 3-Vessel Disease Undergoing Percutaneous Coronary Intervention in the Contemporary Cobalt-Chromium Everolimus-Eluting Stent Era

• Kang J
• Han JK
• Kang DY
• Zheng C
• Yang HM
• Park KW
• Kang HJ
• Koo BK
• Kim HS

• KMID: 2465660
• DOI: http://doi.org/10.4070/kcj.2019.0097

Abstract

BACKGROUND AND OBJECTIVES
The impact of SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery score (SS) and SS II in patients who receive percutaneous coronary intervention with second-generation everolimus-eluting stents (EES) has not been fully validated.
METHODS
The SS, SS II were calculated in 1,248 patients with left main and/or 3-vessel disease treated with EES. Patient-oriented composite endpoint (POCE; all-cause death, any myocardial infarction (MI), any revascularization) and target lesion failure (TLF: cardiac death, target-vessel MI, target lesion revascularization) were analyzed.
RESULTS
The mean SS was 21.1±9.6. Three-year POCE increased according to the SS group (15.2% vs. 19.9% vs. 27.4% for low (≤22), intermediate (≥23, ≤32), high (≥33) SS groups, p<0.001). By multivariate Cox proportional hazard analysis, SS group was an independent predictor of 3-year POCE (hazard ratio, 1.324; 95% confidence interval, 1.095-1.601; p=0.004). The receiver operating characteristic curves revealed that the SS II was superior to the SS for 3-year POCE prediction (area under the curve [AUC]: 0.611 vs. 0.669 for SS vs. SS II, p=0.019), but not for 3-year TLF (AUC: 0.631 vs. 0.660 for SS vs. SS II, p=0.996). In subgroup analysis, SS II was superior to SS in patients with cardiovascular clinical risk factors, and in those presenting as stable angina.
CONCLUSIONS
The usefulness of SS and SS II was still valid in patients with left main and/or 3-vessel disease. SS II was superior to SS for the prediction of patient-oriented outcomes, but not for lesion-oriented outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00698607 ClinicalTrials.gov Identifier: NCT01605721

Keyword

Percutaneous coronary intervention; Drug-eluting stents

MeSH Terms

Angina, Stable
Death
Drug-Eluting Stents
Humans
Myocardial Infarction
Percutaneous Coronary Intervention*
Risk Factors
ROC Curve
Stents*
Taxus
Thoracic Surgery

Figure

• 

  Figure 1 Kaplan-Meier curve according to SS, for (A) 3-year POCE, and (B) 3-year TLF. 3-year POCE and 3-year TLF increased along with SS, in the low-, intermediate-, and high SS group (low SS, SS<23; intermediate SS, 23≤SS≤32); high SS, SS>32). POCE = patient-oriented composite endpoint; SS = SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery score; TLF = target lesion failure.

• 

  Figure 2 Comparison of the SS and SS II. By the AUC of the receiver operating characteristic curve, SS II was superior to SS for predicting 3-year POCE, but equivocal for predicting 3-year TLF. AUC = area under the curve; POCE = patient-oriented composite endpoint; SS = SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery score; TLF = target lesion failure.

• 

  Figure 3 Kaplan-Meier curve according to SS II strata, for (A) 3-year POCE, and (B) 3-year TLF. 3-year POCE and 3-year TLF increased along with SS II, in the low-, intermediate-, and high SS II group (low SS II, SS II<30; intermediate SS II, 30≤SS II≤40); high SS II, SS II>40). POCE = patient-oriented composite endpoint; SS = SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery score; TLF = target lesion failure.

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