Usefulness of the SYNTAX and Clinical SYNTAX Scores in Predicting Clinical Outcome After Unrestricted Use of Sirolimus- and Everolimus-Eluting Stents
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Key result
High SYNTAX scores linked to ~222% higher 1-year risk of major events versus low scores.
- HR 3.221
- 95% CI 2.175-4.769
- P<0.001
- n=5,102
Why the study?
The validity of the SYNTAX score and clinical SYNTAX score in predicting outcomes after PCI with unrestricted use of limus-eluting stents has not been fully investigated in daily practice.
Do the SYNTAX score and clinical SYNTAX score predict 1-year clinical outcomes in patients receiving unrestricted use of sirolimus- and everolimus-eluting stents?
Population
5,102 patients from the EXCELLENT registry undergoing PCI with sirolimus- and everolimus-eluting stents
Comparison
SYNTAX score tertiles (low-SS <8, mid-SS 8–16, high-SS >16) and clinical SYNTAX score
Design
Cohort study
Follow-up
1 year
Authors
Discussion
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Implication
May support SYNTAX-based risk stratification after DES; extends validation to sirolimus- and everolimus-eluting stents but should not yet change practice.
Study Design
Type
Cohort (n=5,102)
Multicenter
Yes
Structured PICO
Do the SYNTAX score and clinical SYNTAX score predict 1-year clinical outcomes in patients receiving unrestricted use of sirolimus- and everolimus-eluting stents?
P
Population
5,102 all-comer patients undergoing percutaneous coronary intervention with unrestricted use of sirolimus- or everolimus-eluting stents, followed for 1 year.
E
Exposure
Risk stratification using SYNTAX score (SS) and clinical SYNTAX score (cSS)
C
Comparator
Comparison across SS tertiles (low-SS <8, 8≤mid-SS≤16, high-SS >16)
O
Outcome
1-year patient-oriented composite endpoint (POCE; all-cause death, any myocardial infarction, and any revascularization) and target-lesion failure (TLF; cardiac death, target-vessel MI, and target-lesion revascularization)composite
Main Result
Hazard Ratio: 3.221 (95% CI 2.175–4.769)
Absolute Event Rate: 12.2% vs 4.2%
p-value: p=<0.001
Both the SYNTAX score and clinical SYNTAX score are valid predictors of 1-year clinical outcomes in patients treated with sirolimus- and everolimus-eluting stents in daily practice.
Limitations
- Not a randomized study, but rather a retrospective observational registry
- Lacked a surgical arm to compare PCI with bypass surgery
- Potential for interobserver and intraobserver variabilities when calculating the SYNTAX score
Cite This Study
Park et al. (2013) conducted a cohort in Coronary artery disease (n=5,102). High SYNTAX score (>16) vs. Low SYNTAX score (<8) was evaluated on Patient-oriented composite endpoint (POCE: all-cause death, any myocardial infarction, and any revascularization) (HR 3.221, 95% CI 2.175-4.769, p=<0.001). Higher SYNTAX scores (>16) were significantly associated with an increased 1-year risk of the patient-oriented composite endpoint compared to low scores (<8) (12.2% vs 4.2%, HR 3.221).
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