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Background <p>The residual SYNTAX score (RSS) is a well-established metric for assessing revascularization and predicting clinical outcomes following percutaneous coronary intervention (PCI); however, this score is limited in its exclusion of relevant clinical parameters. This study evaluated the prognostic utility of the clinical residual SYNTAX score (CRSS) in elderly patients with acute coronary syndrome (ACS) and multiple comorbidities undergoing PCI.</p> Methods <p>This retrospective analysis included 579 elderly patients with ACS and comorbidities who underwent PCI between January 2018 and December 2019. The CRSS was derived by incorporating the Age, Creatinine, Ejection Fraction (ACEF) score into the RSS. Patients were stratified into three revascularization groups: complete revascularization (CR; CRSS = 0), reasonably incomplete revascularization (RICR; 0 &lt; CRSS ≤ 12), and incomplete revascularization (ICR; CRSS &gt; 12). Adverse clinical outcomes were compared among these groups.</p> Results <p>Over a median follow-up of 30 months (95% CI: 25–34), patients in the ICR group exhibited a higher incidence of major adverse clinical outcomes than those in the CR group, whereas no significant differences in all-cause or cardiac death were observed between the CR and RICR groups. After adjustment for potential confounders, multivariable Cox regression analysis revealed that the CRSS was a significant independent predictor of all-cause death, cardiac death, unplanned revascularization, and major adverse cardiovascular events (MACEs). Finally, the CRSS significantly outperformed the traditional RSS in estimating the risks of both all-cause death and cardiac death.</p> Conclusion <p>The results of this study suggest that the CRSS could serve as a valuable prognostic marker, potentially providing clinical utility in evaluating the extent of revascularization for elderly ACS patients with comorbidities undergoing PCI. Compared with the RSS, the CRSS demonstrated significantly greater predictive performance for all-cause death and cardiac death within this cohort.</p>

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The predictive value of the clinical residual SYNTAX score for clinical outcomes in elderly acute coronary syndrome patients with comorbidities undergoing PCI

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月13日

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  • Jun Wang,
  • Hui He,
  • Tao Ye,
  • Xiufen Peng,
  • Qiao Feng,
  • Maoling Jiang,
  • Dongyue Jia,
  • Jie Feng,
  • Hanxiong Liu,
  • Zhen Zhang,
  • Shiqiang Xiong,
  • Lin Cai

摘要

Background

The residual SYNTAX score (RSS) is a well-established metric for assessing revascularization and predicting clinical outcomes following percutaneous coronary intervention (PCI); however, this score is limited in its exclusion of relevant clinical parameters. This study evaluated the prognostic utility of the clinical residual SYNTAX score (CRSS) in elderly patients with acute coronary syndrome (ACS) and multiple comorbidities undergoing PCI.

Methods

This retrospective analysis included 579 elderly patients with ACS and comorbidities who underwent PCI between January 2018 and December 2019. The CRSS was derived by incorporating the Age, Creatinine, Ejection Fraction (ACEF) score into the RSS. Patients were stratified into three revascularization groups: complete revascularization (CR; CRSS = 0), reasonably incomplete revascularization (RICR; 0 < CRSS ≤ 12), and incomplete revascularization (ICR; CRSS > 12). Adverse clinical outcomes were compared among these groups.

Results

Over a median follow-up of 30 months (95% CI: 25–34), patients in the ICR group exhibited a higher incidence of major adverse clinical outcomes than those in the CR group, whereas no significant differences in all-cause or cardiac death were observed between the CR and RICR groups. After adjustment for potential confounders, multivariable Cox regression analysis revealed that the CRSS was a significant independent predictor of all-cause death, cardiac death, unplanned revascularization, and major adverse cardiovascular events (MACEs). Finally, the CRSS significantly outperformed the traditional RSS in estimating the risks of both all-cause death and cardiac death.

Conclusion

The results of this study suggest that the CRSS could serve as a valuable prognostic marker, potentially providing clinical utility in evaluating the extent of revascularization for elderly ACS patients with comorbidities undergoing PCI. Compared with the RSS, the CRSS demonstrated significantly greater predictive performance for all-cause death and cardiac death within this cohort.