Value of the SYNTAX score for risk assessment in the all-comers population of the randomized multicenter LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial.
OBJECTIVE
We aimed to assess the predictive value of the SYNTAX score (SXscore) for major adverse cardiac events in the all-comers population of the LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial.


BACKGROUND
The SXscore has been shown to be an effective predictor of clinical outcomes in patients with multivessel disease undergoing percutaneous coronary intervention.


METHODS
The SXscore was prospectively collected in 1,397 of the 1,707 patients enrolled in the LEADERS trial (patients after surgical revascularization were excluded). Post hoc analysis was performed by stratifying clinical outcomes at 1-year follow-up, according to 1 of 3 SXscore tertiles.


RESULTS
The 1,397 patients were divided into tertiles based on the SXscore in the following fashion: SXscore<or=8 (SXlow) (n=464), SXscore>8 and <or=16 (SXmid) (n=472), and SXscore>16 (SXhigh) (n=461). At 1-year follow-up, there was a significantly lower number of patients with major cardiac event-free survival in the highest tertile of SXscore (SXlow=92.2%, SXmid=91.1%, and SXhigh=84.6%; p<0.001). Death occurred in 1.5% of SXlow patients, 2.1% of SXmid patients, and 5.6% of SXhigh patients (hazard ratio [HR]: 1.97, 95% confidence interval [CI]: 1.29 to 3.01; p=0.002). The myocardial infarction rate tended to be higher in the SXhigh group. Target vessel revascularization was 11.3% in the SXhigh group compared with 6.3% and 7.8% in the SXlow and SXmid groups, respectively (HR: 1.38, 95% CI: 1.1 to 1.75; p=0.006). Composite of cardiac death, myocardial infarction, and clinically indicated target vessel revascularization was 7.8%, 8.9%, and 15.4% in the SXlow, SXmid, and SXhigh groups, respectively (HR: 1.47, 95% CI: 1.19 to 1.81; p<0.001).


CONCLUSIONS
The SXscore, when applied to an all-comers patient population treated with drug-eluting stents, may allow prospective risk stratification of patients undergoing percutaneous coronary intervention. (LEADERS Trial Limus Eluted From A Durable Versus ERodable Stent Coating; NCT00389220).
Wykrzykowska
Joanna J
JJ
Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
Garg
Scot
S
Girasis
Chrysafios
C
de Vries
Ton
T
Morel
Marie-Angele
MA
van Es
Gerrit-Anne
GA
Buszman
Pawel
P
Linke
Axel
A
Ischinger
Thomas
T
Klauss
Volker
V
Corti
Roberto
R
Eberli
Franz
F
Wijns
William
W
Morice
Marie-Claude
MC
di Mario
Carlo
C
van Geuns
Robert Jan
RJ
Juni
Peter
P
Windecker
Stephan
S
Serruys
Patrick W
PW
D000368:Aged; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D011159:Population Surveillance / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index