Author + information
- Received May 20, 2014
- Revision received May 24, 2014
- Accepted May 27, 2014
- Published online October 1, 2014.
- Bo Xu, MBBS∗,
- Philippe Généreux, MD†,‡∗ (, )
- Yuejin Yang, MD∗,
- Martin B. Leon, MD†,
- Liang Xu, MSc∗,
- Shubin Qiao, MD∗,
- Yongjian Wu, MD∗,
- Hongbing Yan, MD∗,
- Jilin Chen, MD∗,
- Yelin Zhao, MSc∗,
- Yanyan Zhao, BS∗,
- Tullio Palmerini, MD§,
- Gregg W. Stone, MD† and
- Runlin Gao, MD∗∗∗ ()
- ∗Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China
- †Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
- ‡Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- §Istituto di Cardiologia, University of Bologna, Bologna, Italy
- ↵∗Reprint requests and correspondence:
Dr. Philippe Généreux, Columbia University Medical Center, Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, New York 10022.
- ↵∗∗Dr. Runlin Gao, Fu Wai Hospital, National Center for Cardiovascular Diseases, A 167, Beilishi Road, Xicheng District, Beijing 100037, China.
Objectives This study sought to evaluate the long-term prognostic capacity of the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score II (SS-II) and compare it with other risk scores among patients undergoing left main percutaneous coronary intervention (LM-PCI).
Background Recently, the SS-II was developed in an attempt to individualize and help the decision-making process between PCI and coronary artery bypass graft (CABG) surgery in the management of complex coronary artery disease (CAD). However, there is a paucity of data regarding the utility of SS-II in patients undergoing LM-PCI.
Methods Data from 1,528 consecutive patients from a single center undergoing unprotected LM-PCI were prospectively collected. The SS-II and other scores were then derived using patients’ baseline clinical characteristics. Patients were stratified according to tertiles of SS-II for PCI: SS-II ≤21 (n = 508), SS-II >21 and ≤28 (n = 480), and >28 (n = 540). Predictive capability for long-term mortality was compared between angiographic scores and scores combining both angiographic and clinical variables.
Results At a mean follow-up of 4.4 years, mortality in the first, second, and third SS-II tertiles was 1.8%, 3.5%, and 9.4%, respectively (p < 0.0001). Multivariate analysis showed SS-II to be a strong independent predictor of mortality (hazard ratio: 1.76, 95% confidence interval: 1.10 to 2.82; p = 0.02) after LM-PCI. When compared with the angiographic SS, scores combining both clinical and angiographic variables, such as the SS-II, were superior in terms of long-term prognostication.
Conclusions Results of this large series of consecutive patients who underwent unprotected LM-PCI suggested that the SS-II has better long-term prognostic power in terms of mortality compared with the original purely angiographic SS.
- coronary artery bypass grafting
- left main
- percutaneous coronary intervention
- SYNTAX score
- SYNTAX score II
Dr. Généreux has received speaker’s fees from Abbott Vascular. Dr. Yang has received research grants from Abbott Vascular, Boston Scientific, Medtronic, MicroPort, Lepu Medical, Sino Medical, and Essen Technology. Dr. Leon is on the Scientific Advisory Board of Abbott Vascular, Boston Scientific, and Medtronic. Dr. Palmerini has received speaker fees from Abbott Vascular. Dr. Stone is a consultant for Boston Scientific and Cardiovascular Systems, Inc. Dr. Gao has received research grants from Abbott Vascular, Boston Scientific, MicroPort, and B Braun. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dr. Xu and Dr. Généreux contributed equally to this work.
- Received May 20, 2014.
- Revision received May 24, 2014.
- Accepted May 27, 2014.
- American College of Cardiology Foundation