| ObjectivesThis retrospective,single-center,observational analysis from prospectively collected database evaluated whether left dominance(LD)affected the long-term outcomes of acute coronary syndrome(ACS)patients undergoing percutaneous coronary intervention(PCI),and whether the effect was independent of SYNTAX score.BackgroundVariations in the balance of the coronary arteries are common.Left dominance is believed to be associated with worse prognoses.The anatomical SYNTAX score is a scoring system based on the complexity and severity of coronary lesions and is thought to be a prognostic tool to predict short-and long-term outcomes.There are few studies about whether the effect of left dominance is independent of SYNTAX score.MethodsBetween January 2013 and December 2013,6255 consecutive ACS patients who were admitted to Fuwai hospital and underwent PCI were enrolled in this study.Based on coronary dominance and the calculation methods of the SYNTAX score,patients were divided into a left-dominant group(LD group;390 patients)and a right-dominant or co-dominant group(RD+Co group,5865 patients).All drug treatment and interventions were conducted according to the guidelines.Clinical follow-up information was obtained from hospital records or by interview with patients,by their relatives directly or by telephone.Follow up information including the development of major adverse cardiac events(MACE)was collected,predefined as all-cause mortality,myocardial infarction,target lesion revascularization,stent thrombosis,and bleeding.Bleeding was quantified according to Thrombolysis in Myocardial Infarction(TIMI)criteria.Other events were defined according to the Academic Research Consortium(ARC)definitions.Continuous variables were expressed as the mean(standard deviation,SD)or median(interquartile range,IQR)and compared by Student t-test or Mann-Whitney U test as appropriate.Categorical variables were expressed as counts and percentages,and comparison was performed using a chi-square test or Fisher' s exact test.The variables tested in the univariate models were selected by the forward stepwise method.To avoid the potential for overfitting in the extensive multivariate Cox regression model,only univariate models with p<0.1 were added to multivariate Cox analysis.Multivariate Cox analysis was used to determine independent predictors of mortality.Adjusted hazard ratios(HRs)and 95%confidence intervals(CIs)were calculated.Additionally,the cumulative survival curves for mortality were constructed by using the Kaplan-Meier method.A two-tailed p value less than 0.05 was considered statistically significant for all comparisons.Statistical analyses were performed by SAS software(version 9.4)for Windows.ResultA total of 6255 consecutive ACS patients treated by PCI were assessed.They were divided into an LD group(390 patients)and an RD+Co group(5865 patients).LD group patients had similar baseline characteristics to RD+Co group patients except for a higher baseline SYNTAX score and lower rate of PCI history and hypercholesterolemia.The ACS Status were similar in the 2 groups.Lesion characteristics were also similar.The number of stents per patients and the rate of successful PCI showed no significant differences.However,patients in the LD group had higher incidences of intra-aortic balloon pump(IABP)support and a lower rate of treatment with GP ?b/?a inhibitors.GFR after PCI and residual SYNTAX score showed no significant differences.The 2-year mortality rate was significantly higher in the LD group than in the RD+Co group(2.58%vs.1.23%,p=0.024).In multivariate Cox analysis,the independent predictors of mortality were coronary dominance,IABP support,age,baseline SYNTAX score,and ejection fraction.ConclusionsLD was an independent predictor of long-term mortality in ACS patients undergoing PCI.The effect of LD still existed after adjustment for several important variables and was independent of SYNTAX score.Age,IABP support,EF and baseline SYNTAX score were also considered independent predictors of long-term mortality.Objectives:This prospective,single-center,observational study evaluated prognostic value of Clinical SYNTAX score(CSS)on 2-year outcomes in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Background:Assessments of individual and population-based outcomes after PCI are extremely important in clinical practice.The SYNTAX score(SS)is a scoring system based on the complexity and severity of coronary lesions to guide decision making between PCI and coronary artery bypass grafting(CABG),and was advocated in both European and American revascularization guidelines.Since the SYNTAX trial,numerous validation studies had proved SS to be an independent predictor of outcome following PCI.The SS was a sole angiographic grading tool only with no consideration for clinical factors.Therefore,recent scores have been developed to combine SS with other clinical parameters,to improve its discriminatory power.CSS combined the SS and a variant of the ACEF(age,creatinine and left ventricular ejection fraction)score,was thought to be a simple and convenient prognostic tool to predict long-term outcomes.In the past studies,CSS has been only validated in multivessel patients with strict patient selection and limited sample.There are few studies investigate the prognostic value of CSS in patients with ACS undergoing PCI in real-world study.Methods:Between January 2013 and December 2013,a total of 10724 consecutive patients were collected.6099 patients were enrolled in this study.Accordingly to CSS,patients were divided into low CSS group(CSS<6.5,2012 patients),mid CSS group(6.5<CSS<13.8,2056 patients)and high CSS group(CSS>13.8,2031 patients).All drug treatment and interventions were conducted according to the guidelines.Clinical follow-up information was obtained from hospital records or by interview with patients,by their relatives directly or by telephone.Follow up information including the development of major adverse cardiac events(MACE)was collected,predefined as all-cause mortality,myocardial infarction,target lesion revascularization(TLR),stent thrombosis,and bleeding.Bleeding was quantified according to Thrombolysis in Myocardial Infarction(TIMI)criteria.Other events were defined according to the Academic Research Consortium(ARC)definitions.Continuous variables were expressed as the mean(standard deviation,SD)or median(interquartile range,IQR)and compared by 1-way ANOVA test for comparison among groups.Categorical variables were expressed as counts and percentages,and comparison was performed using a chi-square test or Fisher's exact test.The variables tested in the univariate models were selected by the forward stepwise method.Multivariate Cox analysis was used to determine independent predictors of mortality.Adjusted hazard ratios(HRs)and 95%confidence intervals(CIs)were calculated.Additionally,the cumulative survival curves for mortality were constructed by using the Kaplan-Meier method.Receiver operator curves(ROC)were used to compare the performance and predictive accuracy of the CSS,baseline SS,RSS and residual CSS for cardiac death and MACE.A two-tailed p value less than 0.05 was considered statistically significant for all comparisons.Statistical analyses were performed by SAS software(version 9.4)for Windows.Result:6099 patients were enrolled in this study.Accordingly to CSS,patients were divided into low CSS group(CSS<6.5,2012 patients),mid CSS group(6.5<CSS<13.8,2056 patients)and high CSS group(CSS>13.8,2031 patients).Compared with patients in the low CSS group,those in the high CSS group were older and more likely to have complex comorbidities.Women were more frequently in the high CSS group.The high CSS group had a more complex angiographic and procedural situation.Patients in the upper tertile were also more likely to have IABP support,GPIIB/IIIA use than the lower tertiles.Medical treatment in hospital were no significant differences among three groups except for the beta-blocker were less taken in the lower tertile.Complete clinical follow-up information for 2 years was available for 6066 patients(99.5%).The 2-year cardiac death rate was significantly higher in the high CSS group than in the mid and low CSS groups(p<0.001).Other adverse cardiac events rates were also numerically higher in the upper tertile except bleeding rate were no significant difference.In multivariate analysis,the independent predictors of cardiac death were CSS,prior PCI,hypertension.In multivariate Cox analyses,increasing CSS was an independent predictor of MACE,along with IABP,diabetes mellitus,successful PCI.The ROC curves for cardiac death and MACE at 2-year follow-up are shown CSS was superior to the baseline SS(AUC 0.738 vs.0.615,p<0.001)and residual SS(AUC 0.738 vs.0.640,p=0.018)in predicting 2-year cardiac death,but wasn't superior in predicting 2-year MACE(AUC 0.597 vs.0.592,p=0.285;0.597 vs.0.610,p=0.262,respectively).Conclusions:In conclusion,compared to the anatomic SS,CSS was suitable in risk stratifying and predicting 2-year clinical outcome among ACS population.Background:Stent thrombosis(ST)is a rare but dreaded complication following percutaneous coronary intervention(PCI),which may associated with severe clinical outcomes,such as sudden death,ST-segment elevation myocardial infarction(STEMI).Drug-eluting stents(DES)have markedly decreased the restenosis rate,but stent thrombosis is still the primary cause of STEMI after PCI.The STEMI patients due to ST remains a therapeutic challenge for the clinician.There are few researches about the safety and effectiveness of primary PCI with second-generation DES for STEMI caused by VLST.Objectives:This retrospective study evaluates the safety,efficacy,and outcomes of primary PCI with second-generation DES for STEMI due to very late stent thrombosis compared with primary PCI for STEMI due to denovo lesion.Methods:Between January 2007 and December 2013,STEMI patients with primary PCI in Fuwai hospital,had only second-generation DES implanted for denovo lesion(558 patients)and VLST(50 patients)were included in this retrospective study.The primary end points were cardiac death and reinfarction.The secondary end points were including cardiac death,reinfarction and TLR.Events were defined according to the Academic Research Consortium(ARC)definitions.Continuous variables were expressed as the mean(standard deviation,SD)or median(interquartile range,IQR)and compared by Student t-test or Mann-Whitney U test as appropriate.Categorical variables were expressed as counts and percentages,and comparison was performed using a chi-square test or Fisher's exact test.The variables tested in the univariate models were selected by the forward stepwise method.Multivariate Cox analysis was used to determine independent predictors of mortality.Adjusted hazard ratios(HRs)and 95%confidence intervals(CIs)were calculated.Additionally,the cumulative survival curves for mortality were constructed by using the Kaplan-Meier method.A two-tailed p value less than 0.05 was considered statistically significant for all comparisons.Statistical analyses were performed by SAS software(version 9.4)for Windows.Result:In 1534 consecutive patients with STEMI treated by primary PCI,50 patients with VLST were implanted with second generation drug-eluting stents,558 patients with denove lesion were implanted with second generation drug-eluting stents.Patients with ST groups had similar baseline to patients with denovo STEMI but a higher rate of PCI and MI history.Lesion characteristic were also similar.The number of stents per patients and diameter of stents were no significant differences but denovo lesion was treated with longer stents.The incidences of IABP support and thrombus aspiration were both no significant differences.In-hospital primary end point and the second end point were no significant differences between two groups(P=1 and P=1,respectively).No significant differences between two groups were observed according to the long-term primary end point and the second end point.Kaplan-Meier survival curves showed no significant different between the 2 groups in the primary end point and the second end point at 2 years(P=0.34 and P=0.243,respectively).According to Cox analysis,female,IABP support and post-procedural TIMI flow 3 were found to be independent predictors for long-term follow-up.Conclusions:Primary PCI with second-generation DES is a reasonable choice for STEMI patients caused by VLST. |
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