C-2 | Association of Pre-Procedural SYNTAX Score With Outcomes After Impella-Assisted High Risk Percutaneous Coronary Intervention – Results from the PROTECT III Study

Patients (pts) with high SYNTAX scores undergoing percutaneous coronary intervention (PCI) have poorer outcomes when compared with pts with lower SYNTAX scores. Whether mechanical circulatory support mitigates the effect of SYNTAX score on high risk PCI (HRPCI) outcomes is unknown Between 3/2017 and 3/2020, 850 pts undergoing Impella-assisted HRPCI in the PROTECT III study had core lab-adjudicated SYNTAX scores. These pts were divided into 3 cohorts based on SYNTAX score – Low (< 22) (N=310); Intermediate (23-32) (N=256); High (> 33) (N=284). Procedural and clinical outcomes out to 90 days were compared between the groups. Multivariable regression analysis was used to assess the impact of SYNTAX score on major adverse cardiovascular and cerebrovascular events (MACCE). Pts with high SYNTAX scores were older than low or intermediate SYNTAX score pts (72.7 vs 69.7 and 70.1 yrs respectively; p=0.002); however, rates of comorbidities were largely similar. At discharge, 1 and 3 months, high SYNTAX score pts had higher MACCE rates when compared with low/intermediate SYNTAX score pts - this was primarily driven by a higher rate of cardiovascular death (Figure). Multivariable analysis revealed that high SYNTAX score was a significant predictor of 90 day MACCE (HR 1.99; 95% CI 1.16-3.42; p=0.013 vs low), while intermediate SYNTAX score was not (HR 0.90; 95% CI 0.47-1.74; p=0.76 vs low). High SYNTAX score is associated with higher rates of 90 day MACCE in pts undergoing Impella-assisted HRPCI. Further research is needed to understand the patient and procedural factors driving this finding.