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.
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.
Valgimigli
Marco
M
Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Serruys
Patrick Washington
PW
Tsuchida
Keiichi
K
Vaina
Sophia
S
Morel
Marie-Angèle
MA
van den Brand
Marcel J
MJ
Colombo
Antonio
A
Morice
Marie Claude
MC
Dawkins
Keith
K
de Bruyne
Bernard
B
Kornowski
Ran
R
de Servi
Stefano
S
Guagliumi
Giulio
G
Jukema
J Wouter
JW
Mohr
Frederick W
FW
Kappetein
Arie-Pieter
AP
Wittebols
Kristel
K
Stoll
Hans-Peter
HP
Boersma
Eric
E
Parrinello
Giovanni
G
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
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D020123:Sirolimus