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Risk Stratification Following Complex PCI: Clinical Versus Anatomical Risk Stratification Including "Post PCI Residual SYNTAX-Score" as Quantification of Incomplete Revascularization

Lookup NU author(s): Professor Ioakim SpyridopoulosORCiD

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Abstract

Background EuroSCORE and completeness of revascularization predicts long-term survival after multivessel PCI (MV-PCI). The SYNTAX-Score has also been proposed to predict clinical outcome. The prognostic impact of these scores to predict long-term survival after PCI has not yet been compared. Methods and Results Long-term survival was assessed in 740 patients undergoing MV-PCI. We calculated EuroSCORE, SYNTAX-Score, STS-Score, the clinical SYNTAX-Score (CSS), and the post-PCI residual SYNTAX-Score. Mean follow-up time was 4.5 +/- 2.5 years. 341 patients (46%) were treated for ACS (STEMI N=191; NSTEMI N=150). 113 patients (15%) underwent PCI of left main coronary artery. The EuroSCORE was significantly lower for stable patients compared to patients with ACS (stable 4.1 +/- 4.5, NSTEMI 13.9 +/- 13.3, STEMI 18.1 +/- 18.7, p<0.001). The differences in the SYNTAX-Score were less obvious but even significant (stable 14.9 +/- 8.6, NSTEMI 17.8 +/- 9.9, STEMI 18.3 +/- 9.0; p<0.001). Patients in the highest tertiles of each risk score experienced a dramatically elevated mortality rate compared to the extremely low mortality rate in the lower tertiles (p log-rank <0.001). This comparison remained significant for the EuroSCORE and STS-Score but not for the SYNTAX-Score, when analysis was restricted to stable patients. The multivariate Cox-regression-analysis confirmed the logistic EuroSCORE, EuroSCORE II, and the STS-Score as independent predictors of long-term mortality, whereas the SYNTAX-Score (including residual form) and the CSS had no predictive value. Conclusion The EuroSCORE and the STS-Score outperforms the SYNTAX-Score and the CSS in predicting long-term survival following MV-PCI. In addition, the residual SYNTAX-Score predicts long-term survival not independently. (J Interven Cardiol 2013;26:29-37)

Publication metadata

Author(s): Schwietz T, Spyridopoulos I, Pfeiffer S, Laskowski R, Palm S, De Rosa S, Jens K, Zeiher AM, Schachinger V, Fichtlscherer S, Lehmann R

Publication type: Article

Publication status: Published

Journal: Journal of Interventional Cardiology

Year: 2013

Volume: 26

Issue: 1

Pages: 29-37

Print publication date: 18/02/2013

ISSN (print): 0896-4327

ISSN (electronic): 1540-8183

Publisher: Wiley-Blackwell Publishing, Inc.

URL: http://dx.doi.org/10.1111/j.1540-8183.2013.12014.x

DOI: 10.1111/j.1540-8183.2013.12014.x

PubMed id: 23419105

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