The Association Between SYNTAX Score and Long-term Outcomes in Patients With Unstable Angina Pectoris: a Single-center Retrospective Study

Background: SYNTAX Score affects clinical outcomes in early studies, whether SYNTAX Score could predict long-term outcomes in patients with unstable angina pectoris (UAP) in the era of new generation drug-eluting stent was unclear, and differences by SYNTAX Score in long-term outcomes between the medical therapy and percutaneous coronary intervention (PCI) in UAP patients were not well known. Methods： In this single-center retrospective study, a total of 2,364 patients with UAP from January 2014 to June 2017 at Beijing Friendship Hospital were enrolled. The primary endpoint was a composite of major adverse cardiovascular events (MACE) , including all-cause death, cardiac death, nonfatal myocardial infarction (MI) and stroke after at least 2 year from discharge. Results： In this study, 1,695 patients had low SYNTAX score (<22) , 432 patients had medium SYNTAX score (22-32), and 237 patients had high SYNTAX score (≥33), and 1,018 received medical therapy, 1,346 patients underwent PCI. Long-term MACE occurred in 95 patients during 3.38 ± 0.99 years follow up. Cox multivariate regression analysis showed advanced age, diabetes mellitus, heart failure, chronic kidney disease (CKD) and high SYNTAX score were independent predictors for MACE in the medical therapy group ( P < 0.05 ), while, heart failure and CKD were predictors of MACE in PCI group. Compared to medical therapy group, PCI group showed lower MACE and cardiac death in patients with high SYNTAX score (≥33) (7.4% vs. 16.7%, P = 0.048; 3.7% vs 14.6%, P = 0.004), but no reduction in patients with low- and medium SYNTAX score. Conclusions： High SYNTAX score could predict long-term MACE for UAP patients with medical therapy, but not for patients undergoing PCI. Compared to medical therapy, PCI could significantly reduced long-term MACE and cardiac death for patients with high SYNTAX score.