Residual SYNTAX score and one-year outcome in elderly patients with acute coronary syndrome

ABSTRACT Background The residual burden of coronary artery disease after PCI has been associated with worse ischemic outcome. However, data are conflicting in elderly patients. The aim of our study was to verify the incremental value of the residual SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery score (rSS) over clinical variables and baseline SS (bSS) in predicting 1-year mortality or cardiovascular events. Methods Post-hoc analysis of data collected in the Elderly-ACS 2 multicenter randomized trial. We included 630 patients aged > 75 years with multivessel coronary disease undergoing PCI for acute coronary syndrome (ACS). The primary outcome was a composite of death, recurrent myocardial infarction and stroke at 1-year follow up. Change in c-statistic and standardized net benefit were used to evaluate the incremental value of the rSS. Results Event rates were significantly higher in patients with incomplete revascularization (rSS >8). When the rSS was included in a core Cox regression model containing age, previous myocardial infarction and ACS type, the HR for patients having score values >8 was 2.47 (95%CI: 1.51-4.06). However, the core model with rSS did not increase the c-statistic as compared to the core model with the bSS (from 0.69 to 0.70) and gave little incremental value in the standardized net benefit. Conclusions In elderly ACS patients with multivessel disease undergoing PCI, incomplete revascularization was associated with worse outcome at 1-year follow-up. However, there was no clear incremental value of the rSS in the prediction of 1-year adverse outcome compared to a model including clinical variables and the bSS.