Prognostic value of SYNTAX score, intravascular ultrasound and near-infrared spectroscopy in coronary disease: 12-year follow-up of ATHEROREMO

Abstract Background and aims This study aims to investigate the very long-term predictive value of the SYNTAX score and plaque characteristics derived by intravascular ultrasound (IVUS) as well as near-infrared spectroscopy (NIRS), for all-cause mortality in patients with low to intermediate complex coronary artery disease. Methods We evaluated 581 patients with chronic or acute coronary syndrome from the European Collaborative Project on Inflammation and Vascular Wall Remodeling in Atherosclerosis (ATHEROREMO) cohort. Flow-limiting lesions were treated with intracoronary stenting. IVUS-VH ( n = 581) and NIRS ( n = 195) images were obtained in a non-culprit segment ≥ 40 mm. Cox models were applied to relate pre-PCI SYNTAX score and plaque characteristics to very long-term all-cause mortality. Adjusted hazard ratios (aHR), corrected for cardiovascular comorbidities and risk factors, are reported per doubling of the corresponding variable. Results Mean (standard deviation) age was 62 (11) years; 76% were men; median SYNTAX score was 9.0 (25th–75th percentile 4.0–15.0). Median follow-up was 12.8 (25th–75th percentile 10.1–13.4) years, and 177 cases of all-cause mortality occurred. SYNTAX score (aHR 1.25, 95% confidence interval [CI] 1.05–1.48; p = 0.012) and percentage dense calcified plaque (aHR 1.21 [1.02–1.42]; p = 0.026) were associated with increased mortality risk, while fibrous plaque (aHR 0.54 [0.34–0.87]; p = 0.011) was related to reduced risk. NIRS features were not associated with very long-term mortality. Conclusion Angiography-based SYNTAX score and IVUS-VH-defined fibrous and dense calcified plaque were related to 12-year mortality in patients with low-to-intermediate complex CAD. Graphical Abstract