Key result
Residual SYNTAX score >8 linked to ~147% higher 1-year risk of death, MI, or stroke.
Why the study?
The residual burden of coronary artery disease after PCI has been associated with worse ischemic outcome, but data are conflicting in elderly patients with ACS.
Does the residual SYNTAX score provide incremental prognostic value over clinical variables and baseline SYNTAX score in elderly patients with ACS undergoing PCI?
Observational (n=630)
Yes
Does the residual SYNTAX score provide incremental prognostic value over clinical variables and baseline SYNTAX score in elderly patients with ACS undergoing PCI?
Hazard Ratio: 2.47 (95% CI 1.51–4.06)
While incomplete revascularization (rSS > 8) predicts worse 1-year outcomes in elderly ACS patients, the residual SYNTAX score does not add incremental prognostic value over baseline SYNTAX score and clinical variables.
Incomplete revascularization signals higher 1-year risk in elderly ACS; leaves open whether residual SYNTAX score adds incremental value beyond baseline and clinical variables.
Background The residual burden of coronary artery disease after percutaneous coronary intervention (PCI) has been associated with worse ischemic outcome. However, data are conflicting in elderly patients. The aim of our study was to verify the incremental value of the residual Syn ergy Between Percutaneous Coronary Intervention With Tax us and Cardiac Surgery (SYNTAX) score (rSS) over clinical variables and baseline SYNTAX score (bSS) in predicting 1-year mortality or cardiovascular events. Methods A post hoc analysis of data collected in the Elderly-ACS 2 multicenter randomized trial was performed. We included 630 patients aged > 75 years with multivessel coronary disease undergoing PCI for acute coronary syndrome (ACS). The primary outcome was a composite of death, recurrent myocardial infarction, and stroke at 1-year follow up. Change in c-statistic and standardized net benefit were used to evaluate the incremental value of the rSS. Results Event rates were significantly higher in patients with incomplete revascularization (rSS > 8). When the rSS was included in a core Cox regression model containing age, previous myocardial infarction, and ACS type, the hazard ratio for patients with score values > 8 was 2.47 (95% confidence interval, 1.51-4.06). However, the core model with rSS did not increase the c-statistic compared with the core model with the bSS (from 0.69 to 0.70) and gave little incremental value in the standardized net benefit. Conclusions In elderly patients with ACS with multivessel disease undergoing PCI, incomplete revascularization was associated with worse outcome at 1-year follow-up. However, there was no clear incremental value of the rSS in the prediction of 1-year adverse outcome compared with a model including clinical variables and bSS.
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Morici et al. (2020) conducted an observational in Acute Coronary Syndrome (n=630). Incomplete revascularization (residual SYNTAX score > 8) vs. Residual SYNTAX score ≤ 8 was evaluated on Composite of death, recurrent myocardial infarction, and stroke at 1-year follow up (HR 2.47, 95% CI 1.51-4.06). Incomplete revascularization (residual SYNTAX score > 8) was associated with a higher 1-year risk of death, recurrent MI, and stroke (HR 2.47; 95% CI 1.51-4.06).
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