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Acute Coronary Syndromes & Interventional Cardiology
29 The use of residual syntax score for prognostication in elderly patients undergoing percutaneous coronary intervention
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  1. Joanna Abramik1,
  2. Nestoras Kontogiannis1,
  3. Roberto Scarsini2,
  4. Giovanni Luigi De Maria2,
  5. Tushar Raina1,
  6. George Kassimis3
  1. 1Gloucestershire Hospitals NHS Foundation Trust
  2. 2Heart Centre, Oxford University Hospitals NHS Trust
  3. 32nd Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece

Abstract

Introduction The residual Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) Score is an objective measure of the degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). A raised residual SYNTAX score (rSYNTAX) has been shown to correlate with significantly increased mortality. Octogenarians are likely to pose the greatest technical challenges in terms of achieving complete revascularisation due to the complexity of their coronary artery disease, vascular calcification requiring the use of adjunctive therapies and limitations related to the use of radiographic contrast due to concomitant renal dysfunction. The aim of our study was to determine the association between incomplete revascularisation, as assessed by the rSYNTAX score, and one-year mortality in octogenarians undergoing PCI.

Methods A retrospective analysis of 665 consecutive octogenarians who underwent emergency or elective PCI at a large non-surgical cardiac centre in the UK between January 2007 and December 2016 was performed. The SYNTAX scores before and after PCI were calculated. Patients were stratified according to terciles of baseline and rSYNTAX score. Furthermore, patients were classified as completely revascularized if the rSYNTAX was equal to 0, or incompletely revascularized otherwise. A residual (rSYNTAX) score of 0 was achieved in 291 (44%) of patients. In multivariate analysis, incomplete revascularisation was found to be an independent predictor of 1-year mortality (OR 1.02(1.01-1.04), p-value 0.014) (Table 1). Increasing rSYNTAX score was associated with reduced survival at 1 year (Figure 1). Other predictors of mortality included age, diabetes mellitus, peripheral vascular disease, raised serum creatinine and presence of cardiogenic shock on presentation. Incomplete revascularisation was also associated with an increased risk of in-hospital complications (p=0.003), including in-hospital death (p <0.0001) (Table 2).

Abstract 29 Figure 1
Abstract 29 Figure 1 Cumulative survival according to residual SYNTAX score ranges at 1 year
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Abstract 29 Table 1 Multivariate analysis of factors associated with increased mortality. OR – odds ratio, 95% CI – 95% confidence interval, MI – myocardial infarction, PCI – percutaneous coronary intervention, CKD – chronic kidney disease, LV – left ventricular, PVD – peripheral vascular disease, CVA – cerebrovascular disease, SYNTAX - Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery, MVD – multivessel disease, LMS-PCI – left main stem percutaneous coronary intervention. In bold – variables showing statistical significance.
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Abstract 29 Table 2 In-hospital complications associated with incomplete revascularisation, as indicated by residual SYNTAX score

Conclusion The residual SYNTAX score is a useful tool in quantifying incomplete revascularisation in patients undergoing PCI for multivessel coronary artery disease. In the octogenarians studied in our cohort, incomplete revascularisation appears to confer a higher one-year mortality and increased risk of in-hospital complications.

Conflict of Interest None

  • Elderly
  • Incomplete revascularisation
  • Prognosis

https://doi.org/10.1136/heartjnl-2020-BCS.29

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