Quantification and Impact of Untreated Coronary Artery Disease After Percutaneous Coronary Intervention the Residual SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) Score

Quantification and Impact of Untreated Coronary Artery Disease After Percutaneous Coronary Intervention the Residual SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) Score

Author Genereux, Philippe Google Scholar
Palmerini, Tullio Google Scholar
Caixeta, Adriano Autor UNIFESP Google Scholar
Rosner, Gregg Google Scholar
Green, Philip Google Scholar
Dressler, Ovidiu Google Scholar
Xu, Ke Google Scholar
Parise, Helen Google Scholar
Mehran, Roxana Google Scholar
Serruys, Patrick W. Google Scholar
Stone, Gregg W. Google Scholar
Institution Columbia Univ
Univ Montreal
Univ Bologna
Universidade Federal de São Paulo (UNIFESP)
Mt Sinai Med Ctr
Erasmus Univ
Abstract Objectives the purpose of this study was to quantify the extent and complexity of residual coronary stenoses following percutaneous coronary intervention (PCI) and to evaluate its impact on adverse ischemic outcomes.Background Incomplete revascularization (IR) after PCI is common, and most studies have suggested that IR is associated with a worse prognosis compared with complete revascularization (CR). However, formal quantification of the extent and complexity of residual atherosclerosis after PCI has not been performed.Methods the baseline Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score (bSS) from 2,686 angiograms from patients with moderate-and high-risk acute coronary syndrome (ACS) undergoing PCI enrolled in the prospective ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial was determined. the SS after PCI was also 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.Results the bSS was 12.8 +/- 6.7, and after PCI the rSS was 5.6 +/- 2.2. Following PCI, 1,084 patients (40.4%) had rSS = 0 (CR), 523 (19.5%) had rSS >0 but <= 2, 578 (21.5%) had rSS >2 but <= 8, and 501 patients (18.7%) had rSS >8. Age, insulin-treated diabetes, hypertension, smoking, elevated biomarkers or ST-segment deviation, and lower ejection fraction were more frequent in patients with IR compared with CR. the 30-day and 1-year rates of ischemic events were significantly higher in the IR group compared with the CR group, especially those with high rSS. By multivariable analysis, rSS was a strong independent predictor of all ischemic outcomes at 1 year, including all-cause mortality (hazard ratio: 1.05, 95% confidence interval: 1.02 to 1.09, p = 0.006).Conclusions the rSS is useful to quantify and risk-stratify the degree and complexity of residual stenosis after PCI. Specifically, rSS >8.0 after PCI in patients with moderate-and high-risk ACS is associated with a poor 30-day and 1-year prognosis. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes; NCT00093158) (J Am Coll Cardiol 2012;59:2165-74) (C) 2012 by the American College of Cardiology Foundation
Keywords ACS
incomplete revascularization
PCI
SYNTAX score
Language English
Sponsor sanofi-aventis
Medicines Company
Abbott Vascular
Bristol-Myers Squibb
AstraZeneca
Date 2012-06-12
Published in Journal of the American College of Cardiology. New York: Elsevier B.V., v. 59, n. 24, p. 2165-2174, 2012.
ISSN 0735-1097 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 2165-2174
Origin http://dx.doi.org/10.1016/j.jacc.2012.03.010
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000304932500006
URI http://repositorio.unifesp.br/handle/11600/34992

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