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

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.

Conflict of interest statement

The authors have no financial conflicts of interest.

Copyright © 2020. The Korean Society of Cardiology.

Figures

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, SS32).

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 II40).

POCE = patient-oriented composite endpoint; SS = SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery score; TLF = target lesion failure.