Risk Stratification Following Complex PCI: Clinical Versus Anatomical Risk Stratification Including “Post PCI Residual SYNTAX‐Score” as Quantification of Incomplete Revascularization

Background

EuroSCORE and completeness of revascularization predicts long‐term survival after multivessel PCI (MV‐PCI). The SYNTAX‐Score has also been proposed to predict clinical outcome. The prognostic impact of these scores to predict long‐term survival after PCI has not yet been compared.

Methods and Results

Long‐term survival was assessed in 740 patients undergoing MV‐PCI. We calculated EuroSCORE, SYNTAX‐Score, STS‐Score, the clinical SYNTAX‐Score (CSS), and the “post‐PCI residual SYNTAX‐Score.” Mean follow‐up time was 4.5 ± 2.5 years. 341 patients (46%) were treated for ACS (STEMI N = 191; NSTEMI N = 150). 113 patients (15%) underwent PCI of left main coronary artery. The EuroSCORE was significantly lower for stable patients compared to patients with ACS (stable 4.1 ± 4.5, NSTEMI 13.9 ± 13.3, STEMI 18.1 ± 18.7, p < 0.001). The differences in the SYNTAX‐Score were less obvious but even significant (stable 14.9 ± 8.6, NSTEMI 17.8 ± 9.9, STEMI 18.3 ± 9.0; p < 0.001). Patients in the highest tertiles of each risk score experienced a dramatically elevated mortality rate compared to the extremely low mortality rate in the lower tertiles (p log‐rank <0.001). This comparison remained significant for the EuroSCORE and STS‐Score but not for the SYNTAX‐Score, when analysis was restricted to stable patients. The multivariate Cox‐regression‐analysis confirmed the logistic EuroSCORE, EuroSCORE II, and the STS‐Score as independent predictors of long‐term mortality, whereas the SYNTAX‐Score (including residual form) and the CSS had no predictive value.

Conclusion

The EuroSCORE and the STS‐Score outperforms the SYNTAX‐Score and the CSS in predicting long‐term survival following MV‐PCI. In addition, the residual SYNTAX‐Score predicts long‐term survival not independently.