TCT-263 Percutaneous Coronary Intervention Risk Stratification: SYNTAX Score Versus Complex PCI Score

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Background: The SYNTAX score is limited by complexity and inter-observer variability. However, the Complex PCI score is a simplified and accessible tool to risk stratify patients undergoing percutaneous coronary intervention (PCI), yet its ability to predict major adverse cardiac events (MACE) is less well studied. Methods: All patients undergoing PCI between 2015 and 2020 were included and SYNTAX scores calculated. The Complex PCI score assigns 1 point to: ≥3 vessel PCI, ≥3 stents, ≥3 lesions treated, a bifurcation with ≥2 stents, stent length ≥60 mm, and chronic total occlusion PCI. The ability of the both scores to predict MACE (all-cause mortality, myocardial infarction, and TVR) at 1 year was compared. Results: Among 16,037 patients, 86% (n = 13,709), 9.8% (n = 1,473), and 5.7% (n = 855) had a low (≤22), intermediate (23-32), and high (≥33) SYNTAX score, respectively. Complex PCI score of 0, 1, and ≥2 was seen in 59% (n = 8,860), 21.8% (n = 3,268), and 21.9% (n = 3,279) of patients, respectively. Higher MACE rate was seen in patients with an intermediate (HR: 2.11 [1.81-2.46]; P < 0.001) and high (HR: 3.70 [3.16-4.33]; P < 0.001) SYNTAX score compared with a low score. A Complex PCI score of 1 (HR: 1.50 [1.31-1.73]; P < 0.001) and ≥2 (HR: 2.05 [1.81-2.33]; P < 0.001) was associated with higher MACE rate compared with score of 0. The discriminator ability to predict MACE of each score was low but comparable. When Complex PCI variables were combined with the SYNTAX score, risk stratification ability improved (likelihood test ratio, P < 0.001). [Formula presented] Conclusion: Both SYNTAX and Complex PCI scores have similar but low discrimination ability in risk stratifying patients undergoing PCI. Further research is needed to develop an intuitive and accurate risk prediction tool. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

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