Valor De La Puntuación SYNTAX II Para La Predicción De Eventos Clínicos En Pacientes Sometidos a Implante Percutáneo De Válvula Aórtica

Introduction and objectives: The predictive value of the SYNTAX score (SS) for clinical outcomes after transcatheter aortic valve implantation (TAVI) is very limited and could potentially be improved by the combination of anatomic and clinical variables, the SS-II. We aimed to evaluate the value of the 55-II in predicting outcomes in patients undergoing TAVI. Methods: A total of 402 patients with severe symptomatic aortic stenosis undergoing transfemoral TAVI were included. Preprocedural TAVI angiograms were reviewed and the SS-I and SS-II were calculated using the SS algorithms. Patients were stratified in 3 groups according to SS-II tertiles. The coprimary endpoints were all-cause death and major adverse cardiovascular events (MACE), a composite of all cause death, cerebrovascular event, or myocardial infarction at 1 year. Results: Increased SS-II was associated with higher 30-day mortality (P = .036) and major bleeding (P = .015). The 1-year risk of death and MACE was higher among patients in the 3 rd SS-II tertile (HR, 2.60; P = .002 and HR, 2.66; P < .001) and was similar among patients in the 2 nd tertile (HR, 1.27; P = .507 and HR, 1.05; P = .895) compared with patients in the 1 st tertile. The highest SS-II tertile was an independent predictor of long-term mortality (P = .046) and MACE (P = .001). Conclusions: The SS-II seems more suited to predict clinical outcomes in patients undergoing TAVI than the SS-I. Increased SS-II was associated with poorer clinical outcomes at 1 and 4 years post-TAVI, independently of the presence of coronary artery disease. (C) 2018 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.