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

Background: The SYNTAX score affects clinical outcomes in early studies. However, the prognostic value of the SYNTAX Score for long-term outcomes and differences by SYNTAX score risk stratification in long-term prognosis between medical therapy and percutaneous coronary intervention (PCI) in patients with unstable angina pectoris (UAP) are not well known in the era of new generation drug-eluting stents and medication. Methods: In this single-centre retrospective study, a total of 2364 patients with UAP from January 2014 to June 2017 at Beijing Friendship Hospital were enrolled. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), including all-cause death, cardiac death, nonfatal myocardial infarction and stroke at least 2 years after discharge. Results: In this study, 1695 patients had low SYNTAX scores (<= 22), 432 patients had medium SYNTAX scores (23-32), 237 patients had high SYNTAX scores (>= 33), 1018 received medical therapy, and 1346 patients underwent PCI. Longterm MACEs occurred in 95 patients during the 3.38 +/- 0.99-year follow-up. Compared to the medical therapy group, the PCI group showed lower MACEs and cardiac death in patients with high SYNTAX scores (7.4% vs. 16.7%, P = 0.048; 3.7% vs. 14.6%, P = 0.004) but no reduction in patients with low and medium SYNTAX scores. Cox multivariate regression analysis showed that advanced age, diabetes mellitus, left ventricular ejection fraction (LVEF), hs-CRP and high SYNTAX score were independent predictors for MACEs in the medical therapy group (P < 0.05), whereas chronic kidney disease (CKD) and LVEF were predictors of MACEs in the PCI group. Conclusions: Compared to medical therapy, PCI could only significantly reduce long-term MACEs and cardiac death for patients with high SYNTAX scores but not for patients with low and medium SYNTAX scores. A high SYNTAX score could predict long-term MACEs for UAP patients in the medical therapy group but not in the PCI group.

Automated summary

This study aimed to investigate the predictive value of the SYNTAX score for long-term outcomes in patients with UAP and the influence of different risk stratifications on medical therapy and PCI. The results showed that PCI could significantly reduce long-term MACEs and cardiac death in patients with high SYNTAX scores, but not in patients with low and medium SYNTAX scores. Furthermore, a high SYNTAX score could predict long-term MACEs for patients in the medical therapy group but not in the PCI group.