title: Objectifying the level of incomplete revascularization by the residual SYNTAX score and evaluating its impact on the one-year outcome of percutaneous coronary intervention in patients with multi-vessel disease.
abstract: BACKGROUND
  Previous studies reported conflicting results regarding the impact of incomplete revascularization on the outcome of percutaneous coronary intervention (PCI). We evaluated the association between residual SYNTAX score (RSS) as a quantitative measure of incomplete revascularization and one-year outcome of patients with native multi-vessel disease undergoing PCI.
  
  
  METHODS
  A total of 760 patients (mean age=59.14±10.36years, 70.4% males) who underwent successful PCI with the incomplete revascularization strategy between September 2008 and March 2010 were included. The RSS was used to quantify the extent and complexity of residual coronary stenosis following PCI. Multivariable analysis was used to evaluate the impact of RSS on one-year major adverse cardiac events (MACE) including death, myocardial infarction, and revascularization.
  
  
  RESULTS
  Overall incidence of one-year MACE was 4.74%. Using ROC curve analysis a cut-off of >5 for baseline RSS had a significant association with occurrence of 12-month MACE (area under the curve=0.769; P value<0.001, sensitivity =75% and specificity=72%). Unadjusted effect of RSS>5 on 12months MACE showed a hazard ratio of 7.34 (p value<0.001). By multivariable analysis, effect of the RSS>5 on 12months MACE was adjusted for potential confounders. After adjustment to clinical SYNTAX score as the sole confounder, RSS>5 remained a strong associate with 12months MACE and its effect outweighed that of before adjustment (hazard ratio=8.03, p value<0.001).
  
  
  CONCLUSIONS
  The RSS is a quantified measure of the complexity of residual coronary stenoses, and RSS>5 could be able to discriminate patients with an increased risk of one-year MACE.
authors.affiliation: Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran. Electronic address: salidoosti@hotmail.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Alidoosti
authors.affiliation: Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran. Electronic address: saroukhani.s.md@gmail.com.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Saroukhani
authors.affiliation: Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran. Electronic address: lotfi21366@yahoo.co.uk.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Lotfi-Tokaldany
authors.affiliation: Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran. Electronic address: arjalali@tums.ac.ir.
authors.forename: Arash
authors.initials: A
authors.lastname: Jalali
authors.affiliation: Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran. Electronic address: rakhshankhah@sina.tums.ac.ir.
authors.forename: Amir
authors.initials: A
authors.lastname: Sobh-Rakhshankhah
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Incomplete revascularization; Percutaneous coronary intervention; Residual SYNTAX score