title: The prognostic utility of the SYNTAX score on 1-year outcomes after revascularization with zotarolimus- and everolimus-eluting stents: a substudy of the RESOLUTE All Comers Trial.
abstract: OBJECTIVE
  This study assessed the ability of the SYNTAX score (SXscore) to stratify risk in patients treated with percutaneous coronary intervention (PCI) using zotarolimus-eluting or everolimus-eluting stents.
  
  
  BACKGROUND
  The SXscore can identify patients treated with PCI who are at highest risk of adverse events.
  
  
  METHODS
  The SXscore was calculated prospectively in 2,033 of the 2,292 patients enrolled in the RESOLUTE All Comers study (RESOLUTE III All Comers Trial: A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention). Clinical outcomes in terms of a patient-oriented composite endpoint (POCE) of all-cause death, myocardial infarction (MI), and repeat revascularization; the individual components of POCE; target lesion failure (TLF) (a composite of cardiac death, target-vessel MI, and clinically driven target lesion revascularization); and stent thrombosis were subsequently stratified according to SXscore tertiles: SXscore(LOW) ≤ 9 (n = 698), 9 <SXscore(MID) ≤ 17 (n = 676); SXscore(HIGH) >17 (n = 659).
  
  
  RESULTS
  At 12-month follow-up, rates of POCE, MI, repeat revascularization, TLF, and the composite of death/MI were all significantly higher in patients in the highest SXscore tercile. Rates of stent thrombosis were all highest in the SXscore(HIGH) tertile (p > 0.05). After multivariate adjustment, the SXscore was identified as an independent predictor of POCE, MI, repeat revascularization, and TLF (p < 0.05 for all). At 12-month follow-up, the SXscore, ACEF score, and Clinical SXscore had C-statistics of 0.57, 0.78, and 0.67, respectively, for mortality and of 0.62, 0.56, 0.63, respectively, for POCE. No significant between-stent differences were observed for TLF or POCE in any of the SXscore tertiles.
  
  
  CONCLUSIONS
  The SYNTAX score is able to stratify risk amongst an all-comers population treated with PCI with second-generation drug-eluting stents (DES); however, improvements can be made with the inclusion of clinical variables. (RESOLUTE III All Comers Trial: A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention; NCT00617084).
authors.affiliation: Department of Interventional Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Scot
authors.initials: S
authors.lastname: Garg
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Sigmund
authors.initials: S
authors.lastname: Silber
authors.forename: Joanna
authors.initials: J
authors.lastname: Wykrzykowska
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.forename: Pawel E
authors.initials: PE
authors.lastname: Buszman
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Adrianus Johannes
authors.initials: AJ
authors.lastname: van Boven
authors.forename: Sjoerd H
authors.initials: SH
authors.lastname: Hofma
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.forename: Volker
authors.initials: V
authors.lastname: Klauss
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.forename: Carlo
authors.initials: C
authors.lastname: DiMario
authors.forename: Ganesh
authors.initials: G
authors.lastname: Manoharan
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: Thomas
authors.initials: T
authors.lastname: Ischinger
authors.forename: Antonio
authors.initials: A
authors.lastname: Bartorelli
authors.forename: Eric
authors.initials: E
authors.lastname: Van Remortel
authors.forename: Jacintha
authors.initials: J
authors.lastname: Ronden
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000401:mortality; D054855:Drug-Eluting Stents; D005060:Europe; D000068338:Everolimus; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; C489443:zotarolimus; D020123:Sirolimus