Reasonable incomplete revascularisation after percutaneous coronary intervention: the SYNTAX Revascularisation Index

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Incomplete revascularisation is a frequent complication following percutaneous coronary intervention (PCI).
• The prognostic significance of the proportion of treated coronary artery disease (CAD) remains unclear.
• Existing metrics do not fully capture the extent of revascularisation achieved.

Purpose of the Study:

• To introduce and validate the SYNTAX Revascularisation Index (SRI) for quantifying the proportion of CAD treated by PCI.
• To assess the impact of the SRI on patient outcomes, specifically one-year mortality.
• To compare the prognostic value of the SRI with existing scores like the residual SYNTAX score (rSS).

Main Methods:

• Calculation of the SRI using baseline SYNTAX score (bSS) and residual SYNTAX score (rSS) from 2,618 patients in the ACUITY trial.
• Analysis of one-year adverse outcomes across different SRI groups (<50%, 50-99%, 100%).
• Evaluation of prognostic accuracy using receiver operating characteristic curves and multivariable analysis.

Main Results:

• The median SRI was 85%, with 41.2% of patients achieving complete revascularisation (SRI=100%).
• Adverse outcomes, including death, were inversely related to the SRI.
• An SRI cut-off of <80% showed prognostic accuracy for death, and SRI was an independent predictor of mortality.
• However, the residual SYNTAX score (rSS) demonstrated superior predictive capability for one-year mortality.

Conclusions:

• The SRI is a novel tool for assessing the degree of revascularisation after PCI.
• An SRI of ≥80% may serve as a target for complete revascularisation.
• Despite its utility, the rSS remains a more potent predictor of one-year mortality.
• Further external validation of the SRI is warranted.