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Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS

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Author(s)
Yuhei KobayashiJacob LønborgAndy JongTakeshi NishiBernard De BruyneDan Eik HøfstenHenning KelbækJamie LaylandChang-Wook NamNico H.J. PijlsPim A.L. ToninoJulie WarnøeKeith G. OldroydColin BerryThomas EngstrømWilliam F. Fearon
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
Journal of the American College of Cardiology
Issued Date
2018
Volume
72
Issue
12
Keyword
acute coronary syndromescomplete revascularizationfractional flow reserveresidual SYNTAX score
Abstract
BACKGROUND
The residual SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (RSS) quantitatively assesses angiographic completeness of revascularization after percutaneous coronary intervention (PCI) and has been shown to be a predictor of events after angiography-guided PCI. In stable patients undergoing functionally complete revascularization with fractional flow reserve (FFR) guidance, RSS did not predict outcome. Whether this is also true in patients with acute coronary syndromes (ACS) is unknown.

OBJECTIVES
The purpose of this study was to determine whether the RSS could predict outcomes in patients with ACS.

METHODS
From the DANAMI-3-PRIMULTI (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation), and FAMOUS-NSTEMI (Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes) trials, 547 patients presented with ACS and underwent functionally complete revascularization. Major adverse cardiac events (MACE) were defined as the composite endpoint of all-cause death, nonfatal myocardial infarction, and any repeat revascularization. The RSS was based on the recalculation of the SYNTAX score after PCI. Wecompared differences in 2-year outcome by the RSS subgroups: 0, 1 to<5, 5 to <10, $10 (RSS ¼ 0 represents angiographically complete revascularization).

RESULTS
The study population consisted of 271 patients with unstable angina/non–ST-segment elevation myocardial infarction and 276 with ST-segment elevation myocardial infarction. The mean RSS was 6.7 5.8. MACE at 2 years occurred in 69 patients (12.6%). Patients with and without MACE had similar RSS after PCI (RSS: 7.2 5.5 vs. 6.6 5.9; p ¼ 0.23). Kaplan-Meier curve analysis showed a similar incidence of MACE regardless of the RSS subgroups (p ¼ 0.54). With and without adjustment of clinical variables, RSS was not a significant predictor of MACE or of each component of MACE.

CONCLUSIONS
After complete revascularization of functionally significant stenosis by FFR, the extent of residual angiographic disease is not associated with subsequent ischemic events in patients presenting with ACS. These results suggest that the concept of functionally complete revascularization is applicable even in ACS patients. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [F.A.M.E.] NCT00267774; Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes [FAMOUS NSTEMI] NCT01764334; Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [DANAMI-3-PRIMULTI]; NCT01960933) (J Am Coll Cardiol 2018;72:1321–9)
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Citation
Yuhei Kobayashi et al. (2018). Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS. Journal of the American College of Cardiology, 72(12), 1321–1329. doi: 10.1016/j.jacc.2018.06.069
Type
Article
ISSN
1558-3597
Source
https://www.sciencedirect.com/science/article/pii/S0735109718355918?via%3Dihub
DOI
10.1016/j.jacc.2018.06.069
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41774
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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