Prognostic Value of Logistic Clinical Syntax Score in Coronary Bifurcation Lesions Treated with Double Stent Technique

Yıl 2022, Cilt: 25 Sayı: 3, 240 - 249, 01.12.2022

Gökhan Demirci Serkan Aslan Ali Rıza Demir Begüm Uygur Ayan Işık Enes Arslan Mehmet Ertürk

Öz

Introduction: In this study, we aimed to investigate the relationship between the preprocedural logistic clinical SYNTAX score (Log CSS) and major cardiovascular events (MACE) in patients with true bifurcation lesions who underwent revascularization with the double stent strategy.

Patients and Methods: A total of 233 non-ST elevation myocardial infarction (NSTEMI) patients who underwent revascularization with a double stent strategy were retrospectively included in the study. Anatomical SYNTAX score (SS) and log CSS were calculated. The patients were divided into two groups according to the cut-off value determined by ROC analysis. The prediction of two-year MACE with Log CSS was evaluated.

Results: MACE developed in 33.9% of patients with high Log CSS and 8.5% of patients with low Log CSS (p< 0.001). In the Kaplan-Meier survival analysis, the long-term survival of the high Log CSS patients was significantly lower than the low Log CSS group (Log-rank p< 0.001). In multivariate COX analyses, high Log CCS (HR= 3.781; 95% CI= 1.706-8.377; p= 0.001) was the strongest independent predictor of MACE.

Conclusion: Log CSS can be a simple and useful tool to predict the development of MACE in patients with true bifurcation lesions revascularized by percutaneous coronary intervention.

Anahtar Kelimeler

Atherosclerosis, percutaneous coronary intervention, percutaneous coronary intervention

Kaynakça

• 1. Steg PG, James SK, Atar D, Badano LP, Blöstrom-Lundqvist C, Borger MA, et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33(20):2569-619. [Crossref]
• 2. Louvard Y, Lefèvre T, Morice MC. Percutaneous coronary intervention for bifurcation coronary disease. Heart 2004;90(6):713-22. [Crossref]
• 3. Bennett J, Dubois C. Coronary bifurcation lesions: Is less more. J Thorac Dis 2016;8(10):1351-4. [Crossref]
• 4. Meier B, Gruentzig AR, King SB, Douglas Jr JS, Hollman J, Ischinger T, et al. Risk of side branch occlusion during coronary angioplasty. Am J Cardiol 1984;53(1):10-4. [Crossref]
• 5. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360(10):961-72. [Crossref]
• 6. Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: An angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005;1(2):219-27.
• 7. Kolh P, Windecker S, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: The task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 2014;46(4):517-92.
• 8. Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA, Masoudi FA, et al. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. J Thorac Cardiovasc Surg 2012;143(4):780-803. [Crossref]
• 9. Sinning JM, Stoffel V, Grube E, et al. Combination of angiographic and clinical characteristics for the prediction of clinical outcomes in patients undergoing unprotected left main coronary artery stenting. Clin Res Cardiol. 2012 Jun;101(6):477-85. [Crossref]
• 10. Garg S, Sarno G, Garcia-Garcia HM, Girasis C, Wykrzykowska J, Dawkins KD, et al. A new tool for the risk stratification of patients with complex coronary artery disease: The clinical SYNTAX score. Circ Cardiovasc Interv 2010;3(4):317-26. [Crossref]
• 11. Farooq V, Vergouwe Y, Räber L, Vranckx P, Garcia H, Diletti R, et al. Combined anatomical and clinical factors for the long-term risk stratification of patients undergoing percutaneous coronary intervention: The logistic clinical SYNTAX score. Eur Heart J 2012;33(24):3098-104. [Crossref]
• 12. Capodanno D, Giacoppo D, Dipasqua F, Micciche E, Licitra C, Di Salvo ME, et al. Usefulness of the logistic clinical SYNTAX score for predicting 1-year mortality in patients undergoing percutaneous coronary intervention of the left main coronary artery. Catheter Cardiovasc Interv 2013;82(4):446-52. [Crossref]
• 13. Farooq V, Vergouwe Y, Généreux P, Bourantas CV, Palmerini T, Caixeta A, et al. Prediction of 1-year mortality in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Validation of the logistic clinical SYNTAX (synergy between percutaneous coronary interventions with taxus and cardiac surgery) score. JACC Cardiovasc Interv 2013;6(7):737-45. [Crossref]
• 14. Stone GW, Sabik JF, Serruys PW, Simonton CA, Genereux P, Puskas J, et al. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med 2016;375(23):2223-35. [Crossref]
• 15. Mohr FW, Morice MC, Kappetein AP, Feldman TE, Stahle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013;381(9876):629-38. [Crossref]
• 16. Capodanno D, Di Salvo ME, Cincotta G, Miano M, Tamburino C, Tamburino C. Usefulness of the SYNTAX score for predicting clinical outcome after percutaneous coronary intervention of unprotected left main coronary artery disease. Circ Cardiovasc Interv 2009;2(4):302-8. [Crossref]
• 17. Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ, et al. Validation of SYNTAX (Synergy between PCI with taxus and cardiac surgery) score for prediction of outcomes after unprotected left main coronary revascularization. JACC Cardiovasc Interv 2010;3(6):612-23. [Crossref]
• 18. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34(38):2949-3003. [Crossref]
• 19. Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. Risk of assessing mortality risk in elective cardiac operations: Age, creatinine, ejection fraction, and the law of parsimony. Circulation 2009;119(24):3053-61. [Crossref]
• 20. Chichareon P, Modolo R, van Klaveren D, Takahashi K, Kogame N, Chang CC, et al. Predictive ability of ACEF and ACEF II score in patients undergoing percutaneous coronary intervention in the GLOBAL LEADERS study. Int J Cardiol 2019;286:43-50. [Crossref]
• 21. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999;16(1):9-13. [Crossref]
• 22. Iqbal J, Vergouwe Y, Bourantas CV, van Klaveren D, Zhang YJ, Campos CM, et al. Predicting 3-year mortality after percutaneous coronary intervention: Updated logistic clinical SYNTAX score based on patient-level data from 7 contemporary stent trials. JACC Cardiovasc Interv 2014;7(5):464-70. [Crossref]
• 23. Chichareon P, Onuma Y, van Klaveren D, Modolo R, Kogame N, Takahashi K, et al. Validation of the updated logistic clinical SYNTAX score for all-cause mortality in the GLOBAL LEADERS trial. EuroIntervention 2019;15(6):539-46. [Crossref]
• 24. Kawashima H, Hara H, Wang R, Ono M, Gao C, Takahashi K, et al. Usefulness of updated logistic clinical SYNTAX score based on MI-SYNTAX score in patients with ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2021;97(7):919-28. [Crossref]
• 25. Uygur B, Demir AR, Guner A, Iyigun T, Uzun N, Celik O. Utility of logistic clinical SYNTAX score in prediction of in-hospital mortality in ST-elevation myocardial infarction patients undergoing emergent coronary artery bypass graft surgery. J Card Surg 2021;36(3):857-863. [Crossref]
• 26. Ozturk D, Celik O, Cakmak HA, Akın F, Aslan S, Enhos A, et al. Usefulness of the logistic clinical syntax score in prediction of saphenous vein graft failure in patients undergoing coronary artery bypass grafting. Angiology 2015;66(8):714-20. [Crossref]
• 27. Latib A, Colombo A. Bifurcation disease: What do we know, what should we do? JACC Cardiovasc Interv 2008;1(3):218-26.
• 28. Chen SL, Zhang JJ, Ye F, Tian NL, Sheiban I, Jepson N, et al. Periprocedural myocardial infarction is associated with increased mortality in patients with coronary artery bifurcation lesions after implantation of a drug-eluting stent. Catheter Cardiovasc Interv 2015;85(1):696-705. [Crossref]
• 29. Colombo A, Chieffo A. Drug-eluting stent update 2007: Part III: Technique and unapproved/unsettled indications (left main, bifurcations, chronic total occlusions, small vessels and long lesions, saphenous vein grafts, acute myocardial infarctions, and multivessel disease). Circulation 2007;116(12):1424-32. [Crossref]
• 30. Steigen TK, Maeng M, Wiseth R, Erglis A, Kumsars I, Narbute I, et al. Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: The Nordic bifurcation study. Circulation 2006;114(18):1955-61. [Crossref]
• 31. Song PS, Song YB, Lee JM, Hahn JY, Choi SH, Choi JH, et al. Major predictors of long-term clinical outcomes after percutaneous coronary intervention for coronary bifurcation lesions with 2-stent strategy: Patient-level analysis of the Korean bifurcation pooled cohorts. JACC Cardiovasc Interv 2016;9(18):1879-86. [Crossref]
• 32. Pillai AA, Gousy VS, Kottyath H, Satheesh S, Selvaraj R, Jayaraman B. Long-term outcomes following left main bifurcation stenting in Indian population-analysis based on SYNTAX I and II scores. Indian Heart J 2018;70(3):394-8. [Crossref]
• 33. Hildick-Smith D, Behan MW, Lassen JF, Chieffo A, Lefevre T, Stankovic G, et al. The EBC TWO Study (European Bifurcation Coronary TWO): A randomized comparison of provisional t-stenting versus a systematic 2 stent culotte strategy in large caliber true bifurcations. Circ Cardiovasc Interv 2016;9(9):003643. [Crossref]