The Prognostic Role of Residual SYNTAX Score in Older Patients with Acute Coronary Syndrome

Approximately half of the patients presenting with acute coronary syndrome have multivessel disease. There has been conflicting data regarding the residual coronary artery disease (CAD) burden and its impact on mortality, especially in older people. Therefore, we aimed to assess all-cause mortality and residual CAD burden in older patients with acute coronary syndrome.

Patients over 75 years of age who presented with acute coronary syndrome and underwent percutaneous coronary intervention were retrospectively included in the study. After the index procedure, residual The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores were calculated and the patients were divided into two groups as residual SYNTAX > 8 and < 8. In-hospital and long-term all-cause mortality were defined as the endpoints of the study.

Overall, 352 patients were included in the study. The mean age was 82.0 ± 4.8 years and 188 (53.4%) patients were female. The median follow-up was 35 (3-57) months. Both in-hospital and long-term mortality were significantly higher in the patients with residual SYNTAX sore > 8 (33.9% vs. 12.0% and 70.1% vs. 48.4% both p < 0.01, respectively). Kaplan-Meier analysis survival curves continued to separate showing increased mortality in the patients with residual SYNTAX score > 8 (p < 0.01). In multivariate Cox regression analysis, high residual CAD burden [residual Syntax score > 8, hazard ratio: 1.83 (1.30-2.56 95% confidence interval), p < 0.01], age, diabetes mellitus, left ventricular ejection fraction and renal insufficiency were associated with long-term all-cause mortality.

Elderly patients with residual SYNTAX score > 8 had higher in-hospital and long-term all-cause mortality rates. Strategies aiming to reduce residual CAD burden by revascularization seem reasonable.