title: Cyphering the complexity of coronary artery disease using the syntax score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention.
abstract: The Syntax score (SXscore) was recently developed as a comprehensive angiographic scoring system aiming to assist in patient selection and risk stratification of patients with extensive coronary artery disease undergoing contemporary revascularization. A validation of this angiographic classification scheme is lacking. We assessed its predictive value in patients who underwent percutaneous intervention (PCI) for 3-vessel disease and explored its performance in comparison with the modified lesion classification system of the American Heart Association/American College of Cardiology. The SXscore, applied to 1,292 lesions in 306 patients who underwent PCI for 3-vessel disease in the Arterial Revascularization Therapies Study Part II, was 4 to 54.5, and after a median of 370 days (range 274 to 400) predicted the rate of major adverse cardiac and cerebrovascular events (hazard ratio 1.08/U increase, 95% confidence interval 1.05 to 1.11, p <0.0001), with patients in the highest SXscore tertile having a significantly higher event rate (27.9%) than patients in the lowest tertile (8.7%, hazard ratio 3.5, 95% confidence interval 1.7 to 7.4, p = 0.001). By multivariable analyses, SXscore independently predicted outcome with an almost fourfold adjusted increase in the risk of major adverse cardiac and cerebrovascular events in patients with high versus low values based on the discrimination level provided by classification and regression tree analysis. Compared with the modified lesion classification scheme of the American Heart Association/American College of Cardiology, SXscore showed a greater discrimination ability (c-index 0.58 +/- 0.08 vs 0.67 +/- 0.08, respectively, p <0.001) and a better goodness of fit with the Hosmer-Lemeshow statistic. In conclusion, the SXscore is a promising tool to risk stratify outcome in patients with extensive coronary artery disease undergoing contemporary PCI.
authors: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Marco
authors: M
authors: Valgimigli
authors: Patrick Washington
authors: PW
authors: Serruys
authors: Keiichi
authors: K
authors: Tsuchida
authors: Sophia
authors: S
authors: Vaina
authors: Marie-Angèle
authors: MA
authors: Morel
authors: Marcel J
authors: MJ
authors: van den Brand
authors: Antonio
authors: A
authors: Colombo
authors: Marie Claude
authors: MC
authors: Morice
authors: Keith
authors: K
authors: Dawkins
authors: Bernard
authors: B
authors: de Bruyne
authors: Ran
authors: R
authors: Kornowski
authors: Stefano
authors: S
authors: de Servi
authors: Giulio
authors: G
authors: Guagliumi
authors: J Wouter
authors: JW
authors: Jukema
authors: Frederick W
authors: FW
authors: Mohr
authors: Arie-Pieter
authors: AP
authors: Kappetein
authors: Kristel
authors: K
authors: Wittebols
authors: Hans-Peter
authors: HP
authors: Stoll
authors: Eric
authors: E
authors: Boersma
authors: Giovanni
authors: G
authors: Parrinello
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D002545:Brain Ischemia / Q000209:etiology; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000145:classification / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents; D020521:Stroke / Q000209:etiology; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D020123:Sirolimus