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

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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.

Original languageEnglish
Pages (from-to)78-88
Number of pages11
JournalClinical Research in Cardiology
Volume115
Issue number1
DOIs
Publication statusPublished - Jan 2026

Bibliographical note

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© The Author(s) 2025.

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