Key result
Doubling the SYNTAX score is linked to ~25% higher 12-year mortality in low-to-intermediate complex CAD.
Why the study?
The very long-term predictive value of SYNTAX score and plaque characteristics derived by IVUS and NIRS for all-cause mortality in low to intermediate complex coronary artery disease was unclear.
Do SYNTAX score and IVUS/NIRS-derived plaque characteristics predict long-term all-cause mortality in patients with low to intermediate complex coronary artery disease?
Cohort (n=581)
Core laboratory blinded to patient characteristics and outcomes
No
Do SYNTAX score and IVUS/NIRS-derived plaque characteristics predict long-term all-cause mortality in patients with low to intermediate complex coronary artery disease?
Answers are grounded in this paper and cite their sources.
Angiography-based SYNTAX score and IVUS-defined plaque characteristics (dense calcified and fibrous plaque) provide prognostic value for 12-year all-cause mortality in patients with low-to-intermediate complex CAD.
BACKGROUND AND AIMS: This study aims to investigate the very long-term predictive value of the SYNTAX score and plaque characteristics derived by intravascular ultrasound (IVUS) as well as near-infrared spectroscopy (NIRS), for all-cause mortality in patients with low to intermediate complex coronary artery disease. METHODS: We evaluated 581 patients with chronic or acute coronary syndrome from the European Collaborative Project on Inflammation and Vascular Wall Remodeling in Atherosclerosis (ATHEROREMO) cohort. Flow-limiting lesions were treated with intracoronary stenting. IVUS-VH (n = 581) and NIRS (n = 195) images were obtained in a non-culprit segment ≥ 40 mm. Cox models were applied to relate pre-PCI SYNTAX score and plaque characteristics to very long-term all-cause mortality. Adjusted hazard ratios (aHR), corrected for cardiovascular comorbidities and risk factors, are reported per doubling of the corresponding variable. RESULTS: Mean (standard deviation) age was 62 (11) years; 76% were men; median SYNTAX score was 9.0 (25th-75th percentile 4.0-15.0). Median follow-up was 12.8 (25th-75th percentile 10.1-13.4) years, and 177 cases of all-cause mortality occurred. SYNTAX score (aHR 1.25, 95% confidence interval [CI] 1.05-1.48; p = 0.012) and percentage dense calcified plaque (aHR 1.21 [1.02-1.42]; p = 0.026) were associated with increased mortality risk, while fibrous plaque (aHR 0.54 [0.34-0.87]; p = 0.011) was related to reduced risk. NIRS features were not associated with very long-term mortality. CONCLUSION: Angiography-based SYNTAX score and IVUS-VH-defined fibrous and dense calcified plaque were related to 12-year mortality in patients with low-to-intermediate complex CAD.
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Meuleman et al. (2025) conducted a cohort in Coronary artery disease (chronic or acute coronary syndrome) (n=581). SYNTAX score vs. Lower scores (analyzed per doubling of the variable) was evaluated on All-cause mortality (aHR 1.25, 95% CI 1.05-1.48, p=0.012). A doubling of the SYNTAX score was associated with a 25% increased risk of 12-year all-cause mortality (aHR 1.25) in patients with low-to-intermediate complex coronary artery disease.
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