The Predictive Value For 1-Year Prognosis Of Residual SYNTAX Score In Patient After Percutaneous Cornary Intervention

ObjectivesThe purpose of the study was to assess the predictive value for 1-year prognosis of residual SYNTAX score in patients after Percutaneous Cornary Intervention(PCI).MethodsThis trail is a muti-center retrospective clinical study.We collected 1246 patients who diagnosed coronary heart disease(CHD)and receive Percutaneous Coronary Intervention treatment from January 2014 to June 2014.A total of 6 hospitals participated in this study,they are General Hospital of Beijing Military Region,PLA,Beijing anzhen hospital,capital medical university,Fuwai hospital,CAMS&PUMC,PEKING UNION MEDICAL COLLEGE HOSPITAL,Jining NO.1 people's hospital,NO.252 hospital,PLA.All enrolled patients were received treatments basis on guidelines and individual condition,researchers didn't interfere.We calculated b SS and r SS,and grouped into three base r SS,compared patients' long-term outcome among CR group(r SS=0)?low residual risk group(0<r SS?8)and high residual risk group(r SS>8).Results1.A total 1246 patients were enrolled.The b SS average 17.1±10.3,ranging from 0 to 64.5,the average of r SS is 6.5±8.0,ranging from 0 to 49.0.362 patients achieved CR(29.1%),555 patients grouped into low residual risk group(44.5%)while 329 patients into high residual risk groups(26.4%).There is an obvious positive correlation between r SS and b SS(r = 0.678,p < 0.01).Tertiled by b SS,IR achieved more in high risk group(b SS>32)than low risk group(b SS<22)(96.3%vs60.6%,P<0.001)2.Compared with CR group and low residual risk group,patients in high residual risk group were more frequent suffering from hypertension(52.9%vs63.4%vs65.7%,P<0.001)? diabetes(18.2%vs21.8%vs27.7%,P=0.011)and smoking(33.4%vs40.8%vs42.2%,P=0.039).STEMI/NSTEMI were more frequent in high residual risk group(22.1%vs31.4%vs33.7%,P=0.001).3.Triple vessel disease(3.9%vs29.4%vs67.8%,P<0.001)?Chronic Total occlusion(0.3%vs11.2%vs42.9%,P<0.001)and bifurcation/trifurcation lesion(15.5%vs22.9%vs25.8%,P=0.002)are more frequent in high residual risk group,double vessel disease was more frequent in low residual risk group(23.2%vs 48.8%vs27.7%,P<0.001).4.A total of 62 MACE were incidented during the follow-up period(5.0%),9 cases of death,6 of cardiac death6 cases,23 of MI,33 of unplanned revascularization(including PCI and CABG),87 of recurrence angina.Among three groups,there were no statistically significant difference in all-cause death and nonfatal myocardial infarction;cardiac death were not occurred in r SS = 0 subgroups,after combined subgroup,r SS?8 group has less cardiac death(0.2%vs1.2%,P = 0.002);Unplanned reascularization,recurrence angina and MACE exist obvious differences among groups(P = 0.001,0.003,< 0.001).5.By Cox single factor regression analysis,r SS is an independent predictor of MACE events [risk ratio(HR)= 1.108,95% confidence interval(CI): 1.056 ~ 1.105,P < 0.001];multivariable factors analysis shows the same result [risk ratio(HR)= 1.082,95% confidence interval(CI): 1.082 ~ 1.111,P < 0.001).ROC curve was carried out on the b SS and r SS,AUC of b SS was 0.682(95% CI: 0.594 ~ 0.770);in r SS was 0.718(95% CI: 0.634 ~ 0.801),Kaplan-Meier analysis shows that MI in three group was no different,unplanned revascularization and MACE in three r SS groups were obvious different(P < 0.001),MACE in CR group and low residual risk group has no difference(P = 0.960,0.136),and the occurrence of MACE in high residual risk group was obviously higher than both(P < 0.05).Conclusion1.Residual SYNTAX score is correlated with SYNTAX score.2.Residual SYNTAX score is an independent predictor of MACE in post-PCI patients.3.Residual SYNTAX score has a better capacity in predicting MACE than SYNTAX score.4.Residual SYNTAX score ?8 can be a rule in CAG-PCI patient for the range of incomplete revascularization.