The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

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Significant association among residual SYNTAX score, non-culprit major adverse cardiac events, and greyscale and virtual histology intravascular ultrasound findings: a substudy from the PROSPECT study

EuroIntervention 2019;14:1676-1684 published online December 2018. DOI: 10.4244/EIJ-D-18-00681

1. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; 2. New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; 3. Imperial College of Science, Technology and Medicine, London, United Kingdom; 4. Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA; 5. Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada

Aims: Residual SYNTAX score (rSS) is known to be associated with cardiac events. We sought to investigate the association between rSS and greyscale and virtual histology (VH)-intravascular ultrasound (IVUS) plaque morphology, and the association between rSS and non-culprit-related major adverse cardiac events (MACE) using data from the PROSPECT study.

Methods and results: A total of 697 patients with acute coronary syndromes were enrolled in the PROSPECT study. Three-vessel greyscale and VH-IVUS were performed. Among them, 688 patients with paired baseline SS or SYNTAX score and rSS were identified and divided into three groups – rSS=0 (n=184), 0 <rSS ≤8 (n=364), and rSS >8 (n=140). MACE was defined as the composite of cardiac death, cardiac arrest, myocardial infarction, or rehospitalisation for unstable or progressive angina. There was a significant difference in the three-year non-culprit-related MACE rates among the three groups (5.7% versus 11.9% versus 19.7%, lowest to highest rSS; p=0.004) mainly due to rehospitalisation for unstable or progressive angina. On multivariable analysis, patients with ≥1 lesion with plaque burden ≥70% or ≥1 lesion with a minimum lumen area ≤4 mm2 and total dense calcium volume per patient were significantly correlated with rSS. Insulin-treated diabetes mellitus, rSS, and patients with ≥1 lesion with plaque burden ≥70% were independent predictors of non-culprit-related MACE.

Conclusions: Plaque morphology based on greyscale IVUS and VH-IVUS was significantly correlated with rSS, and rSS and plaque burden ≥70% independently predicted non-culprit-related MACE.

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