Key result
Higher clinical residual SYNTAX score linked to ~2% increased mortality per point in elderly ACS.
Why the study?
Does the clinical residual SYNTAX score (CRSS) improve prediction of clinical outcomes compared to the traditional residual SYNTAX score in elderly ACS patients with comorbidities undergoing PCI?
Cohort (n=579)
No
Does the clinical residual SYNTAX score (CRSS) improve prediction of clinical outcomes compared to the traditional residual SYNTAX score in elderly ACS patients with comorbidities undergoing PCI?
Hazard Ratio: 1.017 (95% CI 1.008–1.025)
p-value: p=<0.001
The clinical residual SYNTAX score (CRSS) is a superior prognostic marker compared to the traditional residual SYNTAX score for predicting all-cause and cardiac death in elderly ACS patients with comorbidities undergoing PCI.
May refine post-PCI risk stratification in elderly comorbid ACS patients; supports CRSS utility but leaves open prospective validation.
BACKGROUND: The residual SYNTAX score (RSS) is a well-established metric for assessing revascularization and predicting clinical outcomes following percutaneous coronary intervention (PCI); however, this score is limited in its exclusion of relevant clinical parameters. This study evaluated the prognostic utility of the clinical residual SYNTAX score (CRSS) in elderly patients with acute coronary syndrome (ACS) and multiple comorbidities undergoing PCI. METHODS: This retrospective analysis included 579 elderly patients with ACS and comorbidities who underwent PCI between January 2018 and December 2019. The CRSS was derived by incorporating the Age, Creatinine, Ejection Fraction (ACEF) score into the RSS. Patients were stratified into three revascularization groups: complete revascularization (CR; CRSS = 0), reasonably incomplete revascularization (RICR; 0 < CRSS ≤ 12), and incomplete revascularization (ICR; CRSS > 12). Adverse clinical outcomes were compared among these groups. RESULTS: Over a median follow-up of 30 months (95% CI: 25-34), patients in the ICR group exhibited a higher incidence of major adverse clinical outcomes than those in the CR group, whereas no significant differences in all-cause or cardiac death were observed between the CR and RICR groups. After adjustment for potential confounders, multivariable Cox regression analysis revealed that the CRSS was a significant independent predictor of all-cause death, cardiac death, unplanned revascularization, and major adverse cardiovascular events (MACEs). Finally, the CRSS significantly outperformed the traditional RSS in estimating the risks of both all-cause death and cardiac death. CONCLUSION: The results of this study suggest that the CRSS could serve as a valuable prognostic marker, potentially providing clinical utility in evaluating the extent of revascularization for elderly ACS patients with comorbidities undergoing PCI. Compared with the RSS, the CRSS demonstrated significantly greater predictive performance for all-cause death and cardiac death within this cohort.
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Wang et al. (2026) conducted a cohort in Acute coronary syndrome with comorbidities (n=579). Clinical residual SYNTAX score (CRSS) vs. Lower CRSS or traditional residual SYNTAX score (RSS) was evaluated on All-cause death (HR 1.017, 95% CI 1.008-1.025, p=<0.001). The clinical residual SYNTAX score independently predicted all-cause death in elderly ACS patients with comorbidities undergoing PCI, with a 1.7% increase in mortality risk per 1-point increase (HR 1.017).
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