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Utility of the SYNTAX score in predicting outcomes after coronary intervention for chronic total occlusion

Nutzen des SYNTAX-Scores zur Prognoseabschätzung nach Koronarintervention bei chronischem Totalverschluss

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Abstract

Background

Chronic total occlusion (CTO) lesions are a challenging issue. When dealing with complex CTO lesions in patients undergoing percutaneous coronary intervention (PCI), it is important to evaluate not only the CTO lesion itself but also atherosclerotic lesions of the whole coronary artery tree. The utility of the SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Trial) score in patients with CTO undergoing PCI is unclear.

Methods

This retrospective study included 304 consecutive patients with CTO lesions who underwent PCI. Primary endpoints were procedural failure and major adverse cardiac events (MACE) within 30 days. The SYNTAX and J-CTO (Multicenter CTO Registry in Japan) scores were assessed before the procedures, and patients were divided into two groups according to SYNTAX criteria: high (> 22; n = 158) and low (≤ 22; n = 146) SYNTAX scores.

Results

Procedural success was achieved in 252 patients (82.9 %). Patients with a high SYNTAX score had significantly lower procedural success than those with a low SYNTAX score (74.7 % versus 91.8 %, p < 0.0001). There were 13 MACE (8.2 %) in patients with high SYNTAX scores and two MACE (1.4 %) in those with low scores. The SYNTAX and J-CTO scores had odds ratios of 3.33 (95 %CI, 1.44–7.74) and 3.64 (95 %CI, 1.24–10.66) for procedural failure. A higher SYNTAX score (> 22) was also an independent predictor of 30-day MACE after PCI (odds ratio = 4.80, 95 %Cl 1.03–22.42).

Conclusion

The SYNTAX score is predictive of procedural failure, as is the J-CTO score. Furthermore, a higher SYNTAX score is strongly associated with an increased risk of 30-day MACE. The SYNTAX score is useful for clinical decision making when treating patients with complex CTO lesions.

Zusammenfassung

Hintergrund

Läsionen durch chronischen Koronarverschluss („chronic total occlusion“, CTO) stellen immer noch eine Herausforderung dar. Bei der Behandlung komplexer CTO-Läsionen von Patienten, bei denen eine perkutane Koronarintervention (PCI) erfolgt, ist es wichtig, nicht nur die CTO-Läsion selbst, sondern auch atherosklerotische Läsionen des gesamten Koronorarteriensystems zu beurteilen. Der Nutzen des SYNTAX-Scores („the SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery trial“) für Patienten mit CTO, bei denen eine PCI erfolgt, ist noch unklar.

Methoden

Die vorliegende retrospektive Studie umfasste 304 konsekutive Patienten mit CTO-Läsionen, bei denen eine PCI erfolgte. Primäre Endpunkte waren Versagen der Intervention und schwere ungünstige kardiale Ereignisse („major adverse cardiac events, MACE) innerhalb von 30 Tagen. Der SYNTAX- und der J-CTO-Score (Multicenter CTO Registry in Japan) wurden vor der Intervention ermittelt, und die Patienten wurden gemäß den SYNTAX-Kriterien in 2 Gruppen eingeteilt: mit hohem Wert (> 22; n = 158) und mit niedrigem Wert (≤ 22; n = 146).

Ergebnisse

Die Intervention war bei 252 Patienten (82,9 %) erfolgreich. Patienten mit einem hohen SYNTAX-Score wiesen einen signifikant geringeren Interventionserfolg auf als Patienten mit einem niedrigen SYNTAX-Score (74,7 % vs. 91,8 %; p < 0,0001). Es gab 13 MACE (8,2 %) bei Patienten mit hohem SYNTAX-Score und 2 MACE (1,4 %) bei Patienten mit niedrigem Wert. Für den SYNTAX-Score lag die Odds Ratio bei 3,33 (95 %-KI: 1,44–7,74) und für den J-CTO-Score bei 3,64 (95 %-KI: 1,24–10,66) in Bezug auf ein Versagen der Intervention. Ein höherer SYNTAX-Score (> 22) war auch ein unabhängiger Prädiktor eines 30-Tage-MACE nach PCI (Odds Ratio: 4,80; 95 %-Kl: 1,03–22,42).

Schlussfolgerung

Der SYNTAX-Score ist Prädiktor für ein Versagen der Intervention, ebenso wie der J-CTO-Score. Darüber hinaus ist ein höherer SYNTAX-Score stark mit einem erhöhten Risiko für ein 30-Tage-MACE assoziiert. Der SYNTAX-Score ist für die klinische Entscheidungsfindung bei Patienten mit komplexem CTO von Nutzen.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, 153–8515, Tokyo, Japan

    Yoshinori Nagashima, Raisuke Iijima MD, Masato Nakamura & Kaoru Sugi

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  1. Yoshinori Nagashima
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  2. Raisuke Iijima MD
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  3. Masato Nakamura
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  4. Kaoru Sugi
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Correspondence to Raisuke Iijima MD.

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Conflict of interest

Y. Nagashima, R. Iijima, M. Nakamura, and K. Sugi state that there are no conflicts of interest.

Additional information

Y. Nagashima and R. Iijima contributed equally to this work.

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Nagashima, Y., Iijima, R., Nakamura, M. et al. Utility of the SYNTAX score in predicting outcomes after coronary intervention for chronic total occlusion. Herz 40, 1090–1096 (2015). https://doi.org/10.1007/s00059-015-4323-2

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  • DOI: https://doi.org/10.1007/s00059-015-4323-2

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