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. 2020 Jan;50(1):22-34.
doi: 10.4070/kcj.2019.0097. Epub 2019 Sep 30.

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

Jeehoon Kang  1 , Jung Kyu Han  2 , Do Yoon Kang  1 , Chengbin Zheng  1 , Han Mo Yang  1 , Kyung Woo Park  1 , Hyun Jae Kang  1 , Bon Kwon Koo  1 , Hyo Soo Kim  1
Affiliations

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

Jeehoon Kang et al. Korean Circ J. 2020 Jan.

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.

Keywords: Drug-eluting stents; Percutaneous coronary intervention.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1
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
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
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.
See this image and copyright information in PMC

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