Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention

The residual SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score

Philippe Genereux, Tullio Palmerini, Adriano Caixeta, Gregg Rosner, Philip Green, Ovidiu Dressler, Ke Xu, Helen Parise, Roxana Mehran, Patrick W. Serruys, Gregg W. Stone

Research output: Contribution to journalArticle

188 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to quantify the extent and complexity of residual coronary stenoses following percutaneous coronary intervention (PCI) and to evaluate its impact on adverse ischemic outcomes. Background: Incomplete revascularization (IR) after PCI is common, and most studies have suggested that IR is associated with a worse prognosis compared with complete revascularization (CR). However, formal quantification of the extent and complexity of residual atherosclerosis after PCI has not been performed. Methods: The baseline Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score (bSS) from 2,686 angiograms from patients with moderate- and high-risk acute coronary syndrome (ACS) undergoing PCI enrolled in the prospective ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial was determined. The SS after PCI was also assessed, generating the "residual" SS (rSS). Patients with rSS >0 were defined as having IR and were stratified by rSS tertiles, and their outcomes were compared to the CR group. Results: The bSS was 12.8 ± 6.7, and after PCI the rSS was 5.6 ± 2.2. Following PCI, 1,084 patients (40.4%) had rSS = 0 (CR), 523 (19.5%) had rSS >0 but ≤2, 578 (21.5%) had rSS >2 but ≤8, and 501 patients (18.7%) had rSS >8. Age, insulin-treated diabetes, hypertension, smoking, elevated biomarkers or ST-segment deviation, and lower ejection fraction were more frequent in patients with IR compared with CR. The 30-day and 1-year rates of ischemic events were significantly higher in the IR group compared with the CR group, especially those with high rSS. By multivariable analysis, rSS was a strong independent predictor of all ischemic outcomes at 1 year, including all-cause mortality (hazard ratio: 1.05, 95% confidence interval: 1.02 to 1.09, p = 0.006). Conclusions: The rSS is useful to quantify and risk-stratify the degree and complexity of residual stenosis after PCI. Specifically, rSS >8.0 after PCI in patients with moderate- and high-risk ACS is associated with a poor 30-day and 1-year prognosis. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes; NCT00093158).

Original languageEnglish (US)
Pages (from-to)2165-2174
Number of pages10
JournalJournal of the American College of Cardiology
Volume59
Issue number24
DOIs
StatePublished - Jun 12 2012

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Taxus
Percutaneous Coronary Intervention
Thoracic Surgery
Coronary Artery Disease
Acute Coronary Syndrome
Triage
Coronary Stenosis
Catheterization
Heparin
Atherosclerosis
Angiography
Pathologic Constriction
Biomarkers
Smoking
Confidence Intervals
Insulin

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Genereux, Philippe ; Palmerini, Tullio ; Caixeta, Adriano ; Rosner, Gregg ; Green, Philip ; Dressler, Ovidiu ; Xu, Ke ; Parise, Helen ; Mehran, Roxana ; Serruys, Patrick W. ; Stone, Gregg W. / Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention : The residual SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score. In: Journal of the American College of Cardiology. 2012 ; Vol. 59, No. 24. pp. 2165-2174.
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abstract = "Objectives: The purpose of this study was to quantify the extent and complexity of residual coronary stenoses following percutaneous coronary intervention (PCI) and to evaluate its impact on adverse ischemic outcomes. Background: Incomplete revascularization (IR) after PCI is common, and most studies have suggested that IR is associated with a worse prognosis compared with complete revascularization (CR). However, formal quantification of the extent and complexity of residual atherosclerosis after PCI has not been performed. Methods: The baseline Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score (bSS) from 2,686 angiograms from patients with moderate- and high-risk acute coronary syndrome (ACS) undergoing PCI enrolled in the prospective ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial was determined. The SS after PCI was also assessed, generating the {"}residual{"} SS (rSS). Patients with rSS >0 were defined as having IR and were stratified by rSS tertiles, and their outcomes were compared to the CR group. Results: The bSS was 12.8 ± 6.7, and after PCI the rSS was 5.6 ± 2.2. Following PCI, 1,084 patients (40.4{\%}) had rSS = 0 (CR), 523 (19.5{\%}) had rSS >0 but ≤2, 578 (21.5{\%}) had rSS >2 but ≤8, and 501 patients (18.7{\%}) had rSS >8. Age, insulin-treated diabetes, hypertension, smoking, elevated biomarkers or ST-segment deviation, and lower ejection fraction were more frequent in patients with IR compared with CR. The 30-day and 1-year rates of ischemic events were significantly higher in the IR group compared with the CR group, especially those with high rSS. By multivariable analysis, rSS was a strong independent predictor of all ischemic outcomes at 1 year, including all-cause mortality (hazard ratio: 1.05, 95{\%} confidence interval: 1.02 to 1.09, p = 0.006). Conclusions: The rSS is useful to quantify and risk-stratify the degree and complexity of residual stenosis after PCI. Specifically, rSS >8.0 after PCI in patients with moderate- and high-risk ACS is associated with a poor 30-day and 1-year prognosis. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes; NCT00093158).",
author = "Philippe Genereux and Tullio Palmerini and Adriano Caixeta and Gregg Rosner and Philip Green and Ovidiu Dressler and Ke Xu and Helen Parise and Roxana Mehran and Serruys, {Patrick W.} and Stone, {Gregg W.}",
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Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention : The residual SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score. / Genereux, Philippe; Palmerini, Tullio; Caixeta, Adriano; Rosner, Gregg; Green, Philip; Dressler, Ovidiu; Xu, Ke; Parise, Helen; Mehran, Roxana; Serruys, Patrick W.; Stone, Gregg W.

In: Journal of the American College of Cardiology, Vol. 59, No. 24, 12.06.2012, p. 2165-2174.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention

T2 - The residual SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score

AU - Genereux, Philippe

AU - Palmerini, Tullio

AU - Caixeta, Adriano

AU - Rosner, Gregg

AU - Green, Philip

AU - Dressler, Ovidiu

AU - Xu, Ke

AU - Parise, Helen

AU - Mehran, Roxana

AU - Serruys, Patrick W.

AU - Stone, Gregg W.

PY - 2012/6/12

Y1 - 2012/6/12

N2 - Objectives: The purpose of this study was to quantify the extent and complexity of residual coronary stenoses following percutaneous coronary intervention (PCI) and to evaluate its impact on adverse ischemic outcomes. Background: Incomplete revascularization (IR) after PCI is common, and most studies have suggested that IR is associated with a worse prognosis compared with complete revascularization (CR). However, formal quantification of the extent and complexity of residual atherosclerosis after PCI has not been performed. Methods: The baseline Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score (bSS) from 2,686 angiograms from patients with moderate- and high-risk acute coronary syndrome (ACS) undergoing PCI enrolled in the prospective ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial was determined. The SS after PCI was also assessed, generating the "residual" SS (rSS). Patients with rSS >0 were defined as having IR and were stratified by rSS tertiles, and their outcomes were compared to the CR group. Results: The bSS was 12.8 ± 6.7, and after PCI the rSS was 5.6 ± 2.2. Following PCI, 1,084 patients (40.4%) had rSS = 0 (CR), 523 (19.5%) had rSS >0 but ≤2, 578 (21.5%) had rSS >2 but ≤8, and 501 patients (18.7%) had rSS >8. Age, insulin-treated diabetes, hypertension, smoking, elevated biomarkers or ST-segment deviation, and lower ejection fraction were more frequent in patients with IR compared with CR. The 30-day and 1-year rates of ischemic events were significantly higher in the IR group compared with the CR group, especially those with high rSS. By multivariable analysis, rSS was a strong independent predictor of all ischemic outcomes at 1 year, including all-cause mortality (hazard ratio: 1.05, 95% confidence interval: 1.02 to 1.09, p = 0.006). Conclusions: The rSS is useful to quantify and risk-stratify the degree and complexity of residual stenosis after PCI. Specifically, rSS >8.0 after PCI in patients with moderate- and high-risk ACS is associated with a poor 30-day and 1-year prognosis. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes; NCT00093158).

AB - Objectives: The purpose of this study was to quantify the extent and complexity of residual coronary stenoses following percutaneous coronary intervention (PCI) and to evaluate its impact on adverse ischemic outcomes. Background: Incomplete revascularization (IR) after PCI is common, and most studies have suggested that IR is associated with a worse prognosis compared with complete revascularization (CR). However, formal quantification of the extent and complexity of residual atherosclerosis after PCI has not been performed. Methods: The baseline Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score (bSS) from 2,686 angiograms from patients with moderate- and high-risk acute coronary syndrome (ACS) undergoing PCI enrolled in the prospective ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial was determined. The SS after PCI was also assessed, generating the "residual" SS (rSS). Patients with rSS >0 were defined as having IR and were stratified by rSS tertiles, and their outcomes were compared to the CR group. Results: The bSS was 12.8 ± 6.7, and after PCI the rSS was 5.6 ± 2.2. Following PCI, 1,084 patients (40.4%) had rSS = 0 (CR), 523 (19.5%) had rSS >0 but ≤2, 578 (21.5%) had rSS >2 but ≤8, and 501 patients (18.7%) had rSS >8. Age, insulin-treated diabetes, hypertension, smoking, elevated biomarkers or ST-segment deviation, and lower ejection fraction were more frequent in patients with IR compared with CR. The 30-day and 1-year rates of ischemic events were significantly higher in the IR group compared with the CR group, especially those with high rSS. By multivariable analysis, rSS was a strong independent predictor of all ischemic outcomes at 1 year, including all-cause mortality (hazard ratio: 1.05, 95% confidence interval: 1.02 to 1.09, p = 0.006). Conclusions: The rSS is useful to quantify and risk-stratify the degree and complexity of residual stenosis after PCI. Specifically, rSS >8.0 after PCI in patients with moderate- and high-risk ACS is associated with a poor 30-day and 1-year prognosis. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes; NCT00093158).

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DO - 10.1016/j.jacc.2012.03.010

M3 - Article

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

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