Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS
Yuhei Kobayashi1, Jacob Lønborg2, Andy Jong3
1Division of Cardiovascular Medicine, Stanford University Medical Center and Stanford Cardiovascular Institute, Stanford, California.
Journal of the American College of Cardiology
|September 15, 2018
Summary
The residual SYNTAX score (RSS) does not predict outcomes in acute coronary syndrome (ACS) patients who achieve functionally complete revascularization. This finding supports the applicability of FFR-guided complete revascularization in ACS.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- The residual SYNTAX score (RSS) assesses angiographic completeness after PCI and predicts events in angiography-guided PCI.
- In stable patients with FFR-guided complete revascularization, RSS did not predict outcomes.
Purpose of the Study:
- To determine if RSS predicts outcomes in acute coronary syndrome (ACS) patients.
Main Methods:
- 547 ACS patients from three trials (DANAMI-3-PRIMULTI, FAME, FAMOUS-NSTEMI) with functionally complete revascularization were analyzed.
- Major adverse cardiac events (MACE) were tracked for 2 years. RSS was calculated post-PCI.
Main Results:
- Mean RSS was 6.7 ± 5.8. MACE occurred in 12.6% of patients.
- No significant difference in RSS was observed between patients with and without MACE (7.2 ± 5.5 vs. 6.6 ± 5.9; p=0.23).
- Kaplan-Meier analysis showed similar MACE incidence across RSS subgroups (p=0.54). RSS was not a significant predictor of MACE.
Conclusions:
- In ACS patients undergoing FFR-guided complete revascularization, residual angiographic disease (RSS) is not associated with subsequent ischemic events.
- These findings suggest that functionally complete revascularization is a valid concept even for ACS patients.
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