Reasonable incomplete revascularisation after percutaneous coronary intervention

The SYNTAX Revascularisation Index

Philippe Genereux, Carlos M. Campos, Mayank Yadav, Tullio Palmerini, Adriano Caixeta, Ke Xu, Dominic P. Francese, George D. Dangas, Roxana Mehran, Martin B. Leon, Patrick W. Serruys, Gregg W. Stone

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Aims: Incomplete revascularisation is common after percutaneous coronary intervention (PCI). While the absolute amount of residual coronary artery disease (CAD) after PCI has been shown to be associated with worse outcomes, whether the proportion of treated CAD is prognostically important remains to be determined. We sought to quantify the proportion of CAD burden treated by PCI and to evaluate its impact on outcomes using a new prognostic instrument - the SYNTAX Revascularisation Index (SRI). Methods and results: The baseline SYNTAX score (bSS) and residual SYNTAX score (rSS) were determined from 2,618 angiograms of patients enrolled in the prospective ACUITY trial. The SRI was then calculated for each patient using the following formula: SRI=(1-[rSS/bSS])×100. Outcomes were examined according to three SRI groups (SRI=100% [complete revascularisation], 50-99%, and <50%). The median bSS was nine (IQR 5, 16), and after PCI the median rSS was one (IQR 0, 6). The median SRI was 85% (IQR 50, 100), and was 100% in 1,079 patients (41.2%), 50-99% in 907 patients (34.6%), and <50% in 632 patients (24.1%). One-year adverse outcomes, including death, were inversely proportional to the SRI. An SRI cut-off of <80% (present in 1,189 [45.4%] patients after PCI) had the best prognostic accuracy for prediction of death (area under the curve 0.60, 95% confidence interval [CI]: 0.53-0.67, p<0.0001). By multivariable analysis, SRI was an independent predictor of one-year mortality (hazard ratio [HR] 2.17, 95% CI: 1.05-4.35, p=0.03). However, when compared to other scores, the rSS showed superior accuracy and predictive capability for one-year mortality. Conclusions: The SRI is a newly described method for quantifying the proportion of CAD burden treated by PCI. Given its correlation with mortality, and pending external validation, the SRI may be useful in assessing the degree of revascularisation after PCI, with SRI ≥80% representing a reasonable goal. However, the rSS showed superior predictive capability for one-year mortality.

Original languageEnglish (US)
Pages (from-to)634-642
Number of pages9
JournalEuroIntervention
Volume11
Issue number6
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

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Percutaneous Coronary Intervention
Coronary Artery Disease
Mortality
Confidence Intervals
Area Under Curve
Angiography

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Genereux, Philippe ; Campos, Carlos M. ; Yadav, Mayank ; Palmerini, Tullio ; Caixeta, Adriano ; Xu, Ke ; Francese, Dominic P. ; Dangas, George D. ; Mehran, Roxana ; Leon, Martin B. ; Serruys, Patrick W. ; Stone, Gregg W. / Reasonable incomplete revascularisation after percutaneous coronary intervention : The SYNTAX Revascularisation Index. In: EuroIntervention. 2015 ; Vol. 11, No. 6. pp. 634-642.
@article{c940c1a3fc6746c48f6297434d2832b2,
title = "Reasonable incomplete revascularisation after percutaneous coronary intervention: The SYNTAX Revascularisation Index",
abstract = "Aims: Incomplete revascularisation is common after percutaneous coronary intervention (PCI). While the absolute amount of residual coronary artery disease (CAD) after PCI has been shown to be associated with worse outcomes, whether the proportion of treated CAD is prognostically important remains to be determined. We sought to quantify the proportion of CAD burden treated by PCI and to evaluate its impact on outcomes using a new prognostic instrument - the SYNTAX Revascularisation Index (SRI). Methods and results: The baseline SYNTAX score (bSS) and residual SYNTAX score (rSS) were determined from 2,618 angiograms of patients enrolled in the prospective ACUITY trial. The SRI was then calculated for each patient using the following formula: SRI=(1-[rSS/bSS])×100. Outcomes were examined according to three SRI groups (SRI=100{\%} [complete revascularisation], 50-99{\%}, and <50{\%}). The median bSS was nine (IQR 5, 16), and after PCI the median rSS was one (IQR 0, 6). The median SRI was 85{\%} (IQR 50, 100), and was 100{\%} in 1,079 patients (41.2{\%}), 50-99{\%} in 907 patients (34.6{\%}), and <50{\%} in 632 patients (24.1{\%}). One-year adverse outcomes, including death, were inversely proportional to the SRI. An SRI cut-off of <80{\%} (present in 1,189 [45.4{\%}] patients after PCI) had the best prognostic accuracy for prediction of death (area under the curve 0.60, 95{\%} confidence interval [CI]: 0.53-0.67, p<0.0001). By multivariable analysis, SRI was an independent predictor of one-year mortality (hazard ratio [HR] 2.17, 95{\%} CI: 1.05-4.35, p=0.03). However, when compared to other scores, the rSS showed superior accuracy and predictive capability for one-year mortality. Conclusions: The SRI is a newly described method for quantifying the proportion of CAD burden treated by PCI. Given its correlation with mortality, and pending external validation, the SRI may be useful in assessing the degree of revascularisation after PCI, with SRI ≥80{\%} representing a reasonable goal. However, the rSS showed superior predictive capability for one-year mortality.",
author = "Philippe Genereux and Campos, {Carlos M.} and Mayank Yadav and Tullio Palmerini and Adriano Caixeta and Ke Xu and Francese, {Dominic P.} and Dangas, {George D.} and Roxana Mehran and Leon, {Martin B.} and Serruys, {Patrick W.} and Stone, {Gregg W.}",
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Genereux, P, Campos, CM, Yadav, M, Palmerini, T, Caixeta, A, Xu, K, Francese, DP, Dangas, GD, Mehran, R, Leon, MB, Serruys, PW & Stone, GW 2015, 'Reasonable incomplete revascularisation after percutaneous coronary intervention: The SYNTAX Revascularisation Index', EuroIntervention, vol. 11, no. 6, pp. 634-642. https://doi.org/10.4244/EIJY14M10_05

Reasonable incomplete revascularisation after percutaneous coronary intervention : The SYNTAX Revascularisation Index. / Genereux, Philippe; Campos, Carlos M.; Yadav, Mayank; Palmerini, Tullio; Caixeta, Adriano; Xu, Ke; Francese, Dominic P.; Dangas, George D.; Mehran, Roxana; Leon, Martin B.; Serruys, Patrick W.; Stone, Gregg W.

In: EuroIntervention, Vol. 11, No. 6, 01.10.2015, p. 634-642.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Reasonable incomplete revascularisation after percutaneous coronary intervention

T2 - The SYNTAX Revascularisation Index

AU - Genereux, Philippe

AU - Campos, Carlos M.

AU - Yadav, Mayank

AU - Palmerini, Tullio

AU - Caixeta, Adriano

AU - Xu, Ke

AU - Francese, Dominic P.

AU - Dangas, George D.

AU - Mehran, Roxana

AU - Leon, Martin B.

AU - Serruys, Patrick W.

AU - Stone, Gregg W.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Aims: Incomplete revascularisation is common after percutaneous coronary intervention (PCI). While the absolute amount of residual coronary artery disease (CAD) after PCI has been shown to be associated with worse outcomes, whether the proportion of treated CAD is prognostically important remains to be determined. We sought to quantify the proportion of CAD burden treated by PCI and to evaluate its impact on outcomes using a new prognostic instrument - the SYNTAX Revascularisation Index (SRI). Methods and results: The baseline SYNTAX score (bSS) and residual SYNTAX score (rSS) were determined from 2,618 angiograms of patients enrolled in the prospective ACUITY trial. The SRI was then calculated for each patient using the following formula: SRI=(1-[rSS/bSS])×100. Outcomes were examined according to three SRI groups (SRI=100% [complete revascularisation], 50-99%, and <50%). The median bSS was nine (IQR 5, 16), and after PCI the median rSS was one (IQR 0, 6). The median SRI was 85% (IQR 50, 100), and was 100% in 1,079 patients (41.2%), 50-99% in 907 patients (34.6%), and <50% in 632 patients (24.1%). One-year adverse outcomes, including death, were inversely proportional to the SRI. An SRI cut-off of <80% (present in 1,189 [45.4%] patients after PCI) had the best prognostic accuracy for prediction of death (area under the curve 0.60, 95% confidence interval [CI]: 0.53-0.67, p<0.0001). By multivariable analysis, SRI was an independent predictor of one-year mortality (hazard ratio [HR] 2.17, 95% CI: 1.05-4.35, p=0.03). However, when compared to other scores, the rSS showed superior accuracy and predictive capability for one-year mortality. Conclusions: The SRI is a newly described method for quantifying the proportion of CAD burden treated by PCI. Given its correlation with mortality, and pending external validation, the SRI may be useful in assessing the degree of revascularisation after PCI, with SRI ≥80% representing a reasonable goal. However, the rSS showed superior predictive capability for one-year mortality.

AB - Aims: Incomplete revascularisation is common after percutaneous coronary intervention (PCI). While the absolute amount of residual coronary artery disease (CAD) after PCI has been shown to be associated with worse outcomes, whether the proportion of treated CAD is prognostically important remains to be determined. We sought to quantify the proportion of CAD burden treated by PCI and to evaluate its impact on outcomes using a new prognostic instrument - the SYNTAX Revascularisation Index (SRI). Methods and results: The baseline SYNTAX score (bSS) and residual SYNTAX score (rSS) were determined from 2,618 angiograms of patients enrolled in the prospective ACUITY trial. The SRI was then calculated for each patient using the following formula: SRI=(1-[rSS/bSS])×100. Outcomes were examined according to three SRI groups (SRI=100% [complete revascularisation], 50-99%, and <50%). The median bSS was nine (IQR 5, 16), and after PCI the median rSS was one (IQR 0, 6). The median SRI was 85% (IQR 50, 100), and was 100% in 1,079 patients (41.2%), 50-99% in 907 patients (34.6%), and <50% in 632 patients (24.1%). One-year adverse outcomes, including death, were inversely proportional to the SRI. An SRI cut-off of <80% (present in 1,189 [45.4%] patients after PCI) had the best prognostic accuracy for prediction of death (area under the curve 0.60, 95% confidence interval [CI]: 0.53-0.67, p<0.0001). By multivariable analysis, SRI was an independent predictor of one-year mortality (hazard ratio [HR] 2.17, 95% CI: 1.05-4.35, p=0.03). However, when compared to other scores, the rSS showed superior accuracy and predictive capability for one-year mortality. Conclusions: The SRI is a newly described method for quantifying the proportion of CAD burden treated by PCI. Given its correlation with mortality, and pending external validation, the SRI may be useful in assessing the degree of revascularisation after PCI, with SRI ≥80% representing a reasonable goal. However, the rSS showed superior predictive capability for one-year mortality.

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DO - 10.4244/EIJY14M10_05

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