Study Evaluates Relationship of SYNTAX Score and Stent Thrombosis in NSTE-ACS Patients Undergoing PCI

January 1, 2015—A substudy of the ACUITY trial sought to investigate the relationship between the SYNTAX score (SS) and stent thrombosis in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) undergoing percutaneous coronary intervention (PCI). Mayank Yadav, MD, et al published the findings in Catheterization and Cardiovascular Interventions (2015;85:1–10). The investigators concluded that in patients with NSTE-ACS undergoing PCI, the extent and severity of coronary artery disease, as assessed by the SS before revascularization, was strongly associated with the occurrence of stent thrombosis both at 30 days and 1 year.

As summarized in Catheterization and Cardiovascular Interventions, the investigators stratified 2,627 patients undergoing PCI in the ACUITY trial by SS tertile according to the current population (true tertiles, SS < 7, SS = 7–12, and SS > 12) and by the SYNTAX trial (original SYNTAX tertiles, SS < 23, SS = 23–32, and SS > 32). Thirty-day and 1-year rates of definite/probable stent thrombosis were determined for each tertile.

The investigators found that 30 (1.1%) and 41 (1.6%) definite/probable stent thrombosis events occurred by 30 days and 1 year, respectively. When stratified by true tertiles, 30-day and 1-year rates of definite/probable stent thrombosis were significantly greater in the highest tertile (SS > 12; 2% and 2.8%) compared with the intermediate (SS = 7–12; 0.7% and 1.1%) and lowest tertiles (SS < 7; 0.6% and 0.7%); P = .007 and P = .0009, respectively.

When stratified by original SYNTAX tertiles, 30-day and 1-year rates of definite/probable stent thrombosis were significantly greater in the highest (SS > 32; 6.3% and 8.8%) and intermediate tertiles (SS = 23–32; 2.8% and 3.7%) compared with the lowest tertile (SS < 22; 0.8% and 1.2%); P < .0001 for both. By multivariable analysis, the SS was an independent predictor for both 30-day and 1-year definite/probable stent thrombosis, reported the investigators in Catheterization and Cardiovascular Interventions.

These findings were reviewed in a related commentary by Gennaro Giustino, MD, and Roxana Mehran, MD, in Catheterization and Cardiovascular Interventions (2015;85:11–12).

The commentary stated that because SYNTAX score predicts early and late definite/probable stent thrombosis in NSTE-ACS patients, risk stratification by SYNTAX score may help the therapeutic decision-making for stent thrombosis and major adverse cardiovascular event prevention. To improve outcomes in NSTE-ACS with complex coronary artery anatomy, new-generation drug-eluting stents in combination with high-potency antiplatelet drugs and improved adherence to medical therapy may be employed, stated Drs. Giustino and Mehran.