Prognostic Capability of Clinical SYNTAX Score in Patients with Complex Coronary Artery Disease and Chronic Renal Insufficiency Undergoing Percutaneous Coronary Intervention

Mengyao Li^1,2,†, Xu Liu^2,†, Mao Jiang^2,†, Yumeng Lei^1,2, Zhongpei Li¹, Shicheng Li¹, Ying Mao¹, Xufen Cao², Liqiu Yan^1,2,*

Show Less

¹ Department of Cardiology & Dongguan Cardiovascular Research Institute, Dongguan Songshan Lake Central Hospital, Guangdong Medical University, 523326 Dongguan, Guangdong, China

² Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, 061017 Cangzhou, Hebei, China

^*Correspondence: yanliqiu110@163.com (Liqiu Yan)
^†These authors contributed equally.

Rev. Cardiovasc. Med. 2024, 25(1), 18; https://doi.org/10.31083/j.rcm2501018

Submitted: 15 July 2023 | Revised: 28 August 2023 | Accepted: 5 September 2023 | Published: 10 January 2024

(This article belongs to the Special Issue Acute Coronary Syndrome: Diagnosis, Treatment, and Management)

This is an open access article under the CC BY 4.0 license.

Abstract

Background: The SYNTAX score (SS) is useful for predicting clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). The clinical SYNTAX score (CSS), developed by combining clinical parameters with the SS, enhances the risk model’s ability to predict clinical outcomes. However, prior research has not yet evaluated the prognostic capacity of CSS in patients with complex coronary artery disease (CAD) and chronic renal insufficiency (CRI) who are undergoing PCI. We aimed to demonstrate the prognostic potential of CSS in assessing long-term adverse events in this high-risk patient cohort. Methods: A total of 962 patients with left main and/or three-vessel CAD and CRI were enrolled in the study spanning from January 2014 to September 2017. The CSS was calculated by multiplying the SS by the modified age, creatinine, and left ventricular ejection fraction (ACEF) score (age/ejection fraction + 1 for each 10 mL of creatinine clearance $<$ 60 mL/min per 1.73 m ${}^{2}$ ). The patients were categorized into three groups based on their CSS values: low-CSS group (CSS $<$ 18.0, n = 321), mid-CSS group (18.0 $\leq$ CSS $<$ 28.3, n = 317), and high-CSS group (CSS $\geq$ 28.3, n = 324) as per the tertiles of CSS. The primary endpoints were all-cause mortality (ACM) and cardiac mortality (CM). The secondary endpoints included myocardial infarction (MI), unplanned revascularization, stroke, and major adverse cardiac and cerebrovascular events (MACCE). Results: At the median 3-year follow-up, the high-CSS group exhibited higher rates of ACM (19.4% vs. 6.6% vs. 3.6%, p $<$ 0.001), CM (15.6% vs. 5.1% vs. 3.2%, p = 0.003), and MACCE (33.8% vs. 29.0% vs. 20.0%, p = 0.005) in comparison to the low and mid-CSS groups. Multivariable Cox regression analysis revealed that CSS was an independent predictor for all primary and secondary endpoints (p $<$ 0 .05). Moreover, the C-statistics of CSS for ACM (0.666 vs. 0.597, p = 0.021) and CM (0.668 vs. 0.592, p = 0.039) were significantly higher than those of SS. Conclusions: The clinical SYNTAX score substantially enhanced the prediction of median 3-year ACM and CM in comparison with SS in complex CAD and CRI patients following PCI.

Keywords

complex coronary artery disease

chronic renal insufficiency

clinical SYNTAX score

SYNTAX score

percutaneous coronary intervention

Funding

H2021110008/Natural Science Foundation of Hebei Province

172777163/Hebei Provence Key Research Projects

Figures

Fig. 1.

Previous article in this issue

Next article in this issue

Rev. Cardiovasc. Med. Print ISSN 1530-6550 Electronic ISSN 2153-8174