title: Quantification of incomplete revascularization and its association with five-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial validation of the residual SYNTAX score.
abstract: BACKGROUND
  The residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) Score is an objective measure of the degree and complexity of residual stenosis after percutaneous coronary intervention (PCI).
  
  
  RESULTS
  In the randomized PCI cohort of the SYNTAX Trial (n=903), the baseline and residual SYNTAX Scores were calculated. Subjects with a residual SYNTAX Score of 0 were defined as having undergone complete revascularization (CR), and a residual SYNTAX Score >0 as incomplete revascularization (ICR). Five-year clinical outcomes were stratified by CR and ICR (tertiles of the residual SYNTAX Score: >0-4, >4-8, and >8). In the PCI cohort, the mean baseline and residual SYNTAX Scores were 28.4±11.5 and 4.5±6.9, respectively. The mean Δ SYNTAX Score (representative of the burden of disease removed by PCI) was 23.8±10.9. The residual SYNTAX Score was distributed as follows: CR, 0 (n=386, 42.7%); ICR, >0 to 4 (n=184, 20.4%), >4 to 8 (n=167, 18.5%), >8 (n=153, 16.9%). A progressively higher residual SYNTAX Score was shown to be a surrogate marker of increasing clinical comorbidity and anatomic complexity. Subjects with CR or residual SYNTAX Scores ≤8 had comparable 5-year mortality (CR, 8.5%; residual SYNTAX Score >0-4, 8.7%; >4-8, 11.4%; P=0.60). A residual SYNTAX Score >8 was associated with 35.3% all-cause mortality at 5-years (P<0.001). Stratified analyses in the predefined medical treated diabetic and left main subgroups yielded similar results.
  
  
  CONCLUSIONS
  The residual SYNTAX Score was shown to be a powerful indicator of 5-year mortality in the SYNTAX Trial. The residual SYNTAX Score may aid in determining a reasonable level of revascularization.
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands.
authors.forename: Vasim
authors.initials: V
authors.lastname: Farooq
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Christos V
authors.initials: CV
authors.lastname: Bourantas
authors.forename: Yaojun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Takashi
authors.initials: T
authors.lastname: Muramatsu
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
authors.forename: Marie Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ståhle
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Ton
authors.initials: T
authors.lastname: de Vries
authors.forename: Marie-angèle
authors.initials: MA
authors.lastname: Morel
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.forename: Arie-Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000592:standards; D015331:Cohort Studies; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000592:standards*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: coronary disease; drug-eluting stents; myocardial ischemia; percutaneous coronary revascularization; survival analysis