Predictive Value of the Residual SYNTAX Score in Patients With Cardiogenic Shock |
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| Authors: | Olivier Barthélémy Stéphanie Rouanet Delphine Brugier Nicolas Vignolles Benjamin Bertin Michel Zeitouni Paul Guedeney Marie Hauguel-Moreau Georges Hage Pavel Overtchouk Ibrahim Akin Steffen Desch Eric Vicaut Uwe Zeymer Holger Thiele Gilles Montalescot |
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| Institution: | 1. ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France;2. Statistician Unit, StatEthic, Levallois-Perret, France;3. First Department of Medicine, Mannheim University Medical Center, Mannheim, Germany;4. Leipzig Heart Center Leipzig, University of Leipzig, Leipzig, Germany;5. Leipzig Heart Institute, Leipzig, Germany;6. ACTION Study Group, Clinical Research Unit, Lariboisière Hospital, Paris, France;7. Institut für Herzinfarktforschung, Ludwigshafen, Germany |
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| Abstract: | BackgroundIn hemodynamically stable patients, complete revascularization (CR) following percutaneous coronary intervention (PCI) is associated with a better prognosis in chronic and acute coronary syndromes.ObjectivesThis study sought to assess the extent, severity, and prognostic value of remaining coronary stenoses following PCI, by using the residual SYNTAX score (rSS), in patients with cardiogenic shock (CS) related to myocardial infarction (MI).MethodsThe CULPRIT-SHOCK (Culprit Lesion Only Percutaneous Coronary Intervention PCI] Versus Multivessel PCI in Cardiogenic Shock) trial compared a multivessel PCI (MV-PCI) strategy with a culprit lesion–only PCI (CLO-PCI) strategy in patients with multivessel coronary artery disease who presented with MI-related CS. The rSS was assessed by a central core laboratory. The study group was divided in 4 subgroups according to tertiles of rSS of the participants, thereby isolating patients with an rSS of 0 (CR). The predictive value of rSS for the 30-day primary endpoint (mortality or severe renal failure) and for 30-day and 1-year mortality was assessed using multivariate logistic regression.ResultsAmong the 587 patients with an rSS available, the median rSS was 9.0 (interquartile range: 3.0 to 17.0); 102 (17.4%), 100 (17.0%), 196 (33.4%), and 189 (32.2%) patients had rSS = 0, 0 < rSS ≤5, 5 < rSS ≤14, and rSS >14, respectively. CR was achieved in 75 (25.2%; 95% confidence interval CI]: 20.3% to 30.5%) and 27 (9.3%; 95% CI: 6.2% to 13.3%) of patients treated using the MV-PCI and CLO-PCI strategies, respectively. After multiple adjustments, rSS was independently associated with 30-day mortality (adjusted odds ratio per 10 units: 1.49; 95% CI: 1.11 to 2.01) and 1-year mortality (adjusted odds ratio per 10 units: 1.52; 95% CI: 1.11 to 2.07).ConclusionsAmong patients with multivessel disease and MI-related CS, CR is achieved only in one-fourth of the patients treated using an MV-PCI strategy. and the residual SYNTAX score is independently associated with early and late mortality. |
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| Keywords: | cardiogenic shock myocardial infarction residual SYNTAX score ACS"} {"#name":"keyword" "$":{"id":"kwrd0030"} "$$":[{"#name":"text" "_":"acute coronary syndrome bSS"} {"#name":"keyword" "$":{"id":"kwrd0040"} "$$":[{"#name":"text" "_":"baseline SYNTAX score CAD"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"coronary artery disease CR"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"complete revascularization CS"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"cardiogenic shock CLO-PCI"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"culprit lesion–only percutaneous coronary intervention CTO"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"chronic total occlusion MI"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"myocardial infarction MV-PCI"} {"#name":"keyword" "$":{"id":"kwrd0110"} "$$":[{"#name":"text" "_":"multivessel percutaneous coronary intervention PCI"} {"#name":"keyword" "$":{"id":"kwrd0120"} "$$":[{"#name":"text" "_":"percutaneous coronary intervention rSS"} {"#name":"keyword" "$":{"id":"kwrd0130"} "$$":[{"#name":"text" "_":"residual SYNTAX score SYNTAX"} {"#name":"keyword" "$":{"id":"kwrd0140"} "$$":[{"#name":"text" "_":"SYNergy between PCI with TAXUS and Cardiac Surgery |
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