Residual Syntax score as a prognostic variable after percutaneous coronary revascularization of multiple vessels

Abstract

Objectives: to quantify the extent of incomplete revascularization using the Residual Syntax Score and to determine its impact on major adverse events. Methods: retrospective and observational study. We included 452 patients with multivessel coronary angioplasty between January 2010 and June 2016. The follow-up was made through personal or telephonic interview. The patients were divided according to Residual Syntax Score into two groups (≤ 8 and > 8) and were then compared with each other. Results: The Residual Syntax Score varied between 0 and 26.5, median of 0; it was < 8 in 389 patients (86%) and > 8 in the remaining 63. Those patients with Residual Syntax Score < 8 were characterized by being younger (p=0.0024), having less frequency of diabetes (P=0.0480), less history of previous myocardial infarction (p=0.0049), less left ventricular systolic dysfunction (p=0.0024) and less basal Syntax Score (p<0.0001). The intervention was successful in the 97.3% of the cases. In-hospital mortality raised 1.1%. In the follow-up we recorded 47 deaths (11.41%), 25 of which were by cardiovascular causes; 7 non-fatal myocardial infarctions (1.7%) and 46 repeated revascularizations (11.2%). Total mortality appeared to be significantly greater among those patients with Residual Syntax Score > 8 (p=0.0013). Similar differences were observed with regards to total major adverse events (p=0.0460). On the multivariate analysis we identified that the Residual Syntax Score was an independent predictor of both mortality (p=0.0159) and major adverse cardiac events at 4 years (p=0.0477). Conclusions: the magnitude of incomplete revascularization turned out to be an independent prognostic determinant. The goal of achieving a Residual Syntax Score <8 appears to be appropriate and should be considered during the selection and planning of each case.