title: A patient-level pooled analysis assessing the impact of the SYNTAX (synergy between percutaneous coronary intervention with taxus and cardiac surgery) score on 1-year clinical outcomes in 6,508 patients enrolled in contemporary coronary stent trials.
abstract: OBJECTIVE
  This study sought to assess the impact of the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SXscore) on clinical outcomes in patients undergoing percutaneous coronary intervention.
  
  
  BACKGROUND
  The SXscore has been demonstrated to have an ability to predict clinical outcomes in patients undergoing percutaneous revascularization. Current studies are limited by the relatively small number of patients in each SXscore group.
  
  
  METHODS
  Patient-level data from 7 contemporary coronary stent trials were pooled by an independent academic research organization (Cardialysis, Rotterdam, the Netherlands). Analysis was performed on a cohort of 6,508 patients treated with drug-eluting stents and who had calculated SXscores. Clinical outcomes in terms of death, myocardial infarction (MI), repeat revascularization, and major adverse cardiac events (MACE, a composite of death, MI, and repeat revascularization) were subsequently stratified according to SXscore quartiles: SXscore(Q1) ≤ 8 (n = 1,702); 8 < SXscore(Q2) < 15 (n = 1,528); 15 ≤ SXscore(Q3) < 23 (n = 1,620); and SXscore(Q4) ≥ 23 (n = 1,658).
  
  
  RESULTS
  One-year outcomes were available in 6,496 patients (99.8%). At 1-year follow-up, all clinical outcomes including mortality, MI, repeat revascularization, MACE, and definite and any stent thrombosis were all significantly higher in patients in the highest SXscore quartile. Similar trends were observed in a subgroup of 2,093 patients (32.2%) who presented with an ST- or non-ST-segment elevation MI. The rate of MACE among patients with an SXscore > 32 and ≤ 32 was 24.9% and 14.0%, respectively (p < 0.001). The SXscore was identified as an independent predictor of all clinical outcomes including mortality, MACE, and stent thrombosis (p < 0.001 for all).
  
  
  CONCLUSIONS
  This study confirms the consistent ability of the SXscore to identify patients who are at highest risk of adverse events.
authors.affiliation: Department of Interventional Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Scot
authors.initials: S
authors.lastname: Garg
authors.forename: Giovanna
authors.initials: G
authors.lastname: Sarno
authors.forename: Chrysafios
authors.initials: C
authors.lastname: Girasis
authors.forename: Pascal
authors.initials: P
authors.lastname: Vranckx
authors.forename: Ton
authors.initials: T
authors.lastname: de Vries
authors.forename: Michael
authors.initials: M
authors.lastname: Swart
authors.forename: Marco
authors.initials: M
authors.lastname: Bressers
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.forename: Gerrit-Anne
authors.initials: GA
authors.lastname: van Es
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000295:instrumentation / Q000379:methods*; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D020946:Taxus; D016896:Treatment Outcome
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel