BACKGROUND In hemodynamically stable patients, complete revascularization (CR) following percutaneous coronary intervention (PCI) is associated with a better prognosis in chronic and acute coronary syndromes. OBJECTIVES This study sought to assess the extent, severity, and prognostic value of remaining coronary stenoses following PCI, by using the residual SYNTAX score (rSS), in patients with cardiogenic shock (CS) related to myocardial infarction (MI). METHODS The CULPRIT-SHOCK (Culprit Lesion Only Percutaneous Coronary Intervention [PCI] Versus Multivessel PCI in Cardiogenic Shock) trial compared a multivessel PCI (MV-PCI) strategy with a culprit lesion-only PCI (CLO-PCI) strategy in patients with multivessel coronary artery disease who presented with MI-related CS. The rSS was assessed by a central core laboratory. The study group was divided in 4 subgroups according to tertiles of rSS of the participants, thereby isolating patients with an rSS of 0 (CR). The predictive value of rSS for the 30-day primary endpoint (mortality or severe renal failure) and for 30-day and 1-year mortality was assessed using multivariate logistic regression. RESULTS Among the 587 patients with an rSS available, the median rSS was 9.0 (interquartile range: 3.0 to 17.0); 102 (17.4%), 100 (17.0%), 196 (33.4%), and 189 (32.2%) patients had rSS = 0, 0 < rSS ≤5, 5 < rSS ≤14, and rSS >14, respectively. CR was achieved in 75 (25.2%; 95% confidence interval [CI]: 20.3% to 30.5%) and 27 (9.3%; 95% CI: 6.2% to 13.3%) of patients treated using the MV-PCI and CLO-PCI strategies, respectively. After multiple adjustments, rSS was independently associated with 30-day mortality (adjusted odds ratio per 10 units: 1.49; 95% CI: 1.11 to 2.01) and 1-year mortality (adjusted odds ratio per 10 units: 1.52; 95% CI: 1.11 to 2.07). CONCLUSIONS Among patients with multivessel disease and MI-related CS, CR is achieved only in one-fourth of the patients treated using an MV-PCI strategy. and the residual SYNTAX score is independently associated with early and late mortality.

中文翻译：

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残差SYNTAX评分对心源性休克患者的预测价值

背景 在血流动力学稳定的患者中，经皮冠状动脉介入治疗 (PCI) 后的完全血运重建 (CR) 与慢性和急性冠状动脉综合征的更好预后相关。目的 本研究旨在通过使用残余 SYNTAX 评分 (rSS) 评估与心肌梗塞 (MI) 相关的心源性休克 (CS) 患者 PCI 后剩余冠状动脉狭窄的程度、严重程度和预后价值。方法 CULPRIT-SHOCK（Culprit Lesion Only Percutaneous Coronary Intervention [PCI] Versus Multivessel PCI in Cardiogenic Shock）试验在多支血管患者中比较了多支血管 PCI（MV-PCI）策略和仅罪犯病变 PCI（CLO-PCI）策略出现 MI 相关 CS 的冠状动脉疾病。rSS 由中央核心实验室评估。根据参与者的 rSS 的三分位数将研究组分为 4 个亚组，从而隔离 rSS 为 0 (CR) 的患者。使用多变量逻辑回归评估 rSS 对 30 天主要终点（死亡率或严重肾功能衰竭）以及 30 天和 1 年死亡率的预测价值。结果 在 587 名具有 rSS 的患者中，中位 rSS 为 9.0（四分位距：3.0 至 17.0）；分别有 102 (17.4%)、100 (17.0%)、196 (33.4%) 和 189 (32.2%) 名患者的 rSS = 0、0 < rSS ≤5、5 < rSS ≤14 和 rSS > 14。使用 MV-PCI 和 CLO-治疗的患者中有 75 名（25.2%；95% 置信区间 [CI]：20.3% 至 30.5%）和 27 名（9.3%；95% CI：6.2% 至 13.3%）达到 CR PCI 策略，分别。经过多次调整，rSS 与 30 天死亡率（每 10 个单位调整后的优势比：1.49；95% CI：1.11 至 2.01）和 1 年死亡率（每 10 个单位调整后优势比：1.52；95% CI：1.11 至 2.07）独立相关. 结论 在多支血管病变和 MI 相关 CS 患者中，仅四分之一使用 MV-PCI 策略治疗的患者达到 CR。残差 SYNTAX 评分与早期和晚期死亡率独立相关。