title: Modified residual SYNTAX score and clinical outcomes in patients with multivessel disease undergoing percutaneous coronary intervention.
abstract: OBJECTIVE
  We sought to determine a reasonable level of revascularisation using the modified residual SYNergy between percutaneous coronary intervention (PCI) with TAXus and cardiac surgery (SYNTAX) score in patients undergoing PCI.
  
  
  RESULTS
  In 3,460 patients with multivessel disease receiving drug-eluting stents, residual SYNTAX score (rSS) was calculated for lesions with ≥50% diameter stenosis in vessels ≥1.5 mm after PCI. The "modified" rSS (mrSS) was determined by counting lesions with ≥70% diameter stenosis in vessels ≥2.5 mm only. Patients were categorised into the complete revascularisation (CR) group (rSS=0), the incomplete revascularisation (ICR) group (mrSS >0), or the reasonable ICR (R-ICR) group (rSS >0, but mrSS=0). After propensity matching, the R-ICR group (n=1,129) had a comparable risk of all-cause death (HR 0.80, 95% CI: 0.56-1.15, p=0.24) and a composite of all-cause death, myocardial infarction (MI), or repeat revascularisation (HR 0.91, 95% CI: 0.74-1.14, p=0.41) compared with the CR group (n=637) at three years. In separate propensity matching analyses, patients with R-ICR (n=1,280) had a lower risk of all-cause death (HR 0.73, 95% CI: 0.55-0.97, p=0.03) and a composite of all-cause death, MI, or repeat revascularisation (HR 0.68, 95% CI: 0.57-0.82, p<0.001) than those with ICR (n=837) at three years.
  
  
  CONCLUSIONS
  Complete revascularisation of lesions with ≥70% diameter stenosis in vessels ≥2.5 mm is better than ICR, and is a reasonable goal for patients with multivessel disease.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Taek Kyu
authors.initials: TK
authors.lastname: Park
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Yang
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Joonghyun
authors.initials: J
authors.lastname: Ahn
authors.forename: Keumhee Cho
authors.initials: KC
authors.lastname: Carriere
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000601:surgery; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D018570:Risk Assessment; D016896:Treatment Outcome