Atherosclerosis. 2026 Apr 25;416:120689. doi: 10.1016/j.atherosclerosis.2026.120689. Online ahead of print.
ABSTRACT
BACKGROUND: The residual SYNTAX score (rSS) quantifies coronary artery disease extent following percutaneous coronary intervention (PCI) and predicts adverse outcomes. However, its relationship with plaque morphology in acute coronary syndrome (ACS) remains unclear.
OBJECTIVE: To investigate associations between rSS and optical coherence tomography (OCT)-defined culprit lesion morphology and assess rSS prognostic impact on 1-year outcomes in ACS patients.
METHODS: This pre-specified subanalysis of the TACTICS registry enrolled 611 ACS patients with plaque rupture (PR), plaque erosion (PE), or calcified nodule (CN) undergoing OCT-guided emergency PCI. Patients were stratified by rSS: 0, 0 < rSS ≤5, 5 < rSS ≤10, and rSS >10. The primary outcome was major adverse cardiac events (MACE): cardiovascular death, myocardial infarction, heart failure, or ischemia-driven revascularization.
RESULTS: PR was most common (66.5%), followed by PE (31.0%) and CN (2.6%). Median rSS was significantly higher in CN than PR and PE (p < 0.001). At 1 year, MACE occurred in 8.0%, 15.0%, 11.8%, and 18.8% of patients with rSS = 0, 0 < rSS ≤5, 5 < rSS ≤10, and rSS >10, respectively (p = 0.016). Higher rSS associated with lower PE probability (OR: 0.95; 95% CI: 0.92-0.98; p = 0.002) and higher CN probability (OR: 1.10; 95% CI: 1.05-1.14; p < 0.001). CN (HR: 4.44; p = 0.022) and rSS (HR: 1.04; p = 0.015) independently predicted adverse outcomes.
CONCLUSION: Higher residual SYNTAX scores were associated with CN morphology and worse clinical outcomes in ACS patients, suggesting that combined anatomical and morphological assessment may enhance post-PCI risk stratification.
PMID:42048680 | DOI:10.1016/j.atherosclerosis.2026.120689