Age-dependent Impact of the SYNTAX-score on Longer-term Mortality After Percutaneous Coronary Intervention in an All-comer Population

Overview

Journal J Geriatr Cardiol

Specialty Geriatrics

Date 2018 Oct 23

PMID 30344539

Citations 4

Authors

Madeleine Eickhoff

Stefanie Schupke

Alexander Khandoga

Julia Fabian

Moritz Baquet

David Jochheim

David Grundmann

Manuela Thienel

Axel Bauer

Hans Theiss

Stefan Brunner

Jorg Hausleiter

Steffen Massberg

Julinda Mehilli

Affiliations

Soon will be listed here.

Abstract

Background: The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX)-score is a validated tool for risk stratification and revascularization strategy selection in patients with complex coronary artery disease. The aim of this study was to analyse its age-related prognostic value.

Methods: SYNTAX-score was calculated in 1331 all-comer patients undergoing percutaneous coronary intervention (PCI): 463 patients ≥ 75 years and 868 patients < 75 years. Outcomes of interest were all-cause mortality at one and two years.

Results: A significant interaction of age and SYNTAX-score for mortality was observed at two-year ( = 0.019) but not at one-year follow-up ( = 0.594). In multivariable analysis, SYNTAX-score independently predicted 1-year mortality in both age groups (< 75 years, hazard ratio (HR): 1.43, 95% confidence intervals (CI): 1.03-2.00, = 0.034; and ≥ 75 years, HR: 1.37, 95% CI: 1.01-1.85, = 0.042), but only two-year mortality among younger patients (< 75 years, HR: 1.33, 95% CI: 1.01-1.76, = 0.041; and ≥ 75 years, HR: 1.11, 95% CI: 0.87-1.41, = 0.394). SYNTAX-score tertiles were useful to stratify 1-year mortality in both, patients < 75 years (SYNTAX-score < 9, 3.8%; 9-20, 5.3%; ≥ 20, 10.3%; = 0.004) and ≥ 75 years (SYNTAX-score < 11, 5.7%; 11-22.5, 16.1%; ≥ 22.5, 18.7%; = 0.003), but two-year mortality only among patients < 75 years (SYNTAX-score < 9, 6.5%; 9-20, 7.6%; ≥ 20, 15%; < 0.001) and not among ≥ 75 years old patients (SYNTAX-score < 11, 19.4%; 11-22.5, 26.3%; ≥ 22.5, 27.9%; = 0.138).

Conclusions: Age modifies the impact of the SYNTAX-score on longer-term mortality after PCI. Among patients < 75 years, the SYNTAX-score independently predicts the risk of death at one and two years after PCI, while among patients ≥ 75 years its predictive role is limited to the first year after PCI. Further studies are needed to evaluate the value of SYNTAX-score for selecting the most appropriate revascularization strategy among elderly patients.

Citing Articles

Angiographic and Procedural Characteristics in Frail Older Patients with Non-ST Elevation Acute Coronary Syndrome.

Beska B, Ratcovich H, Bagnall A, Burrell A, Edwards R, Egred M Interv Cardiol. 2023; 18:e04.

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The potential of HEART score to detect the severity of coronary artery disease according to SYNTAX score.

Salimi A, Zolghadrasli A, Jahangiri S, Hatamnejad M, Bazrafshan M, Izadpanah P Sci Rep. 2023; 13(1):7228.

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The association between SYNTAX score and long-term outcomes in patients with unstable angina pectoris: a single-centre retrospective study.

Xu M, Chen H, Li H BMC Cardiovasc Disord. 2022; 22(1):155.

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Kucuk U, Duygu A, Kirilmaz B Cureus. 2021; 13(2):e13618.

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