Background: Complete revascularization (CR) is infrequent in patients with multivessel coronary artery disease treated with percutaneous coronary intervention (PCI). Trial data on the advantages of CR compared to incomplete revascularization is conflicting . Furthermore, there is no consensus as to the definition of “adequate” CR. The residual SYNTAX score (rSS), which grades revascularization completeness, has been shown to be directly correlated to long term adverse cardiovascular clinical outcomes in a post hoc analysis of the SYNTAX trial.
Our aim was to asses the relation of the rSS at different cutoff levels to major adverse cardiovascular and cerebrovascular adverse events (MACCE) in a “real life” cohort of patients with triple vessel/left main coronary artery disease (3V/LMCAD).
Methods: We studied 145 consecutive patients with 3V/LMCAD who were treated by PCI. The SS and rSS were calculated and we compared MACCE at 3 years follow up using different rSS cutoff values (4/8) as markers of CR.
Results: The demographic and clinical characteristics of the two groups were similar. MACCE at 3 years follow up was significantly lower in the CR group regardless of the rSS cutoff value tested (19.4 Vs 51.1% for rSS cutoff 8, p=0.0001 and 19 Vs 43.6% for rSS cutoff 4, p=0.022. See figure 1) . the difference was driven mainly by need for repeat revascularization (8.6 Vs 28.9% for rSS cutoff 8,p=0.0027 and 6.5 Vs 24.8% for rSS cutoff 4,p=0.0264 . See figure 2) , all other individual components of MACCE showed a strong trend in favor of CR that did not reach statistical significance. A combined endpoint of mortality/myocardial infarction/cerebrovascular accident again was significantly lower in the CR group, only when using a rSS cutoff value of 8 (8.6 Vs 28.9%, p=0.03. See figure 3).
Conclusions: CR as assessed by lower rSS (at cutoff value of 4/8) carries significant long term clinical benefit for patients with 3V/LMCAD treated by PCI .
