ABSTRACT
Background: SYNTAX score II [SS II] integrates anatomical SS with clinical characteristics allowing an individualized prediction of long-term mortality
Aims: We sought to assess to evaluate the usefulness of SS II in a real-world acute coronary syndromes [ACS] population with severe coronary artery disease [CAD] undergoing percutaneous coronary intervention [PCI]
Methods: From August 2011 to May 2013, out of 1591 consecutive patients admitted for ACS, 217 [13.6%] showed severe CAD [three-vessel disease and/or left main involvement]. Among the latter, 100 patients underwent PCI and were enrolled into the study. SS II was calculated in all patients. One-year clinical follow-up was performed; major adverse cardiac and cerebrovascular events [MACCE] were defined as a composite of death, nonfatal myocardial infarction, stroke, or repeat revascularization
Results: The median SS II was 29 [range, 14-59]. Overall, MACCE occurred in 25% of patients [cardiac death 4%, myocardial infarction 4%, stroke 0%, and repeat revascularization 17%]. The 1-year MACCE-free survival was significantly lower in patients with SS [>/=29], than in those with SS II [<29] [64.2% vs. 87.2%, respectively; p=0.007]. In multivariate Cox regression analysis, the presence of unprotected left main stenosis [hazard ratio 2.52, 95% confidence interval [CI]: 1.02-5.85; p=0.031] and SS II >/=29 [hazard ratio 2.74, 95% CI: 1.30-8.21; p=0.011] were the only predictors of MACCE at 1-year clinical follow-up. The c-index of SS score II was 0.70 [95% CI: 0.58-0.81]. For patients who experienced MACCE, the SS II reclassification improved by 36%, while in nonevent patients the reclassification improved by 22%. The net reclassification index was 0.24 [p=0.09]
Conclusion: SS II might represent a useful tool to predict clinical events in not only ideal stable patients, but also an unrestricted, real world population of patients with ACS and severe CAD undergoing PCI