The Prognostic Value of Residual Gensini Score on Long Term Cardiac Mortality in Patients Undergoing Percutaneous Coronary Intervention

Abstract

Background: Percutaneous Coronary Intervention (PCI) is a cornerstone in the management of obstructive coronary artery disease. The Gensini score quantitatively assesses the severity and complexity of coronary lesions. The Residual Gensini Score (rGensini), measured after PCI, may offer superior prognostic information compared to the baseline score. This study aims to investigate the association between the rGensini and cardiac mortality.

Methods: In this study, all consecutive patients who did register for follow-up at the Afshar hospital's health promotion center within 30 days post-PCI were included. The primary outcome was cardiac mortality. Baseline characteristics, comorbidities (diabetes, hypertension, dyslipidemia, prior cardiac history), smoking status, family history, coronary dominance pattern, and coronary calcification were recorded. Patients were stratified into four risk categories based on rGensini: Zero-risk (0), Low-risk (0< to ≤11), Moderate-risk (>11 to ≤37), and High-risk (>37). Survival analysis was performed using the Kaplan-Meier method, and independent predictors of cardiac mortality were identified using Cox proportional hazards regression.

Results: The study included 141 patients (85 men, 56 women) with a mean age of 60.67 years. The mean baseline Gensini score was 31.22, which was reduced to a mean rGensini of 18.20 post-PCI. Over a mean follow-up of 264.1 days (range: 90-365 days), 10 cardiac deaths occurred. Kaplan-Meier curves demonstrated a significant gradation in survival probability across the strata. Multivariable Cox regression analysis identified rGensini category, age, coronary calcification, diabetes and hypertension as independent predictors of cardiac mortality.

Conclusion: The Residual Gensini Score is a powerful independent predictor of cardiac mortality following PCI.