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The concept of reasonable incomplete revascularization (IR) has been proposed. The residual SYNTAX score (rSS), measured after PCI, has been assessed as an independent predictor of long-term clinical outcome and a tool for quantification of IR through several post hoc analysis of clinical trial, and still needs to be validated in various PCI population. And when using rSS to determine an objective level of reasonable incomplete revascularization, whether proximal left anterior descending coronary artery (pLAD) lesion deserves more attention is currently undefined.
The calculations of baseline SYNTAX score (bSS) and rSS were carried out in 10,343 consecutive patients undergoing coronary drug-eluting stents (DES, majority are second-generation DES) implantation in Fuwai Hospital from January 2013 to December 2013. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause death, myocardial infarction (MI) and any revascularization. Secondary endpoints included the individual components of the MACE, cardiac death and all-cause death/MI. Statistical analyses were conducted using SAS version 9.4.
Complete revascularization (CR) (rSS=0) was achieved in 5,050 patients (48.8%). 5,293 patients with IR (51.2%) were stratified according to rSS tertiles: 0<rSS≤4 (18.4%), 2<rSS≤9 (17.2%), and rSS >9 (15.5%). Compared with CR group, the 30-month rates of MACE and all other endpoint events were significantly higher in the IR group. And adverse events rates increased significantly with increasing rSS tertiles. MACE and cardiac death rates were significantly higher among patients with residual pLAD stenosis≥70%. rSS and residual pLAD stenosis≥70% were both strong independent predictors of MACE. Compared with rSS, rSS+ residual pLAD was superior in predicting 30-month MACE.
Higher rSS was associated with progressively increasing rates of adverse clinical outcomes, especially rSS>9. The present study enriched the application of rSS and revealed its limitation. Residual pLAD lesion still affects the prognosis of the patients with comparative rSS level. With no pLAD lesion left, CR and low rSS are still a goal to be achieved.
CORONARY: PCI Outcomes