title: Combined anatomical and clinical factors for the long-term risk stratification of patients undergoing percutaneous coronary intervention: the Logistic Clinical SYNTAX score.
abstract: BACKGROUND
  The SYNTAX score (SXscore), an anatomical-based scoring tool reflecting the complexity of coronary anatomy, has established itself as an important long-term prognostic factor in patients undergoing percutaneous coronary intervention (PCI). The incorporation of clinical factors may further augment the utility of the SXscore to longer-term risk stratify the individual patient for clinical outcomes.
  
  
  RESULTS
  Patient-level merged data from >6000 patients in seven contemporary coronary stent trials was used to develop a logistic regression model-the Logistic Clinical SXscore-to predict 1-year risk for all-cause death and major adverse cardiac events (MACE). A core model (composed of the SXscore, age, creatinine clearance, and left ventricular ejection fraction) and an extended model [incorporating the core model and six additional (best performing) clinical variables] were developed and validated in a cross-validation procedure. The core model demonstrated a substantial improvement in predictive ability for 1-year all-cause death compared with the SXscore in isolation [area under the receiver operator curve (AUC): core model: 0.753, SXscore: 0.660]. A minor incremental benefit of the extended model was shown (AUC: 0.791). Consequently the core model alone was retained in the final the Logistic Clinical SXscore model. Validation plots confirmed the model predictions to be well calibrated. For 1-year MACE, the addition of clinical variables did not improve the predictive ability of the SXscore, secondary to the SXscore being the predominant determinant of all-cause revascularization.
  
  
  CONCLUSIONS
  The Logistic Clinical SXscore substantially enhances the prediction of 1-year mortality after PCI compared with the SXscore, and allows for an accurate personalized assessment of patient risk.
authors.affiliation: Department of Interventional Cardiology,  Erasmus University Medical Centre, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam,  The Netherlands.
authors.forename: Vasim
authors.initials: V
authors.lastname: Farooq
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Vergouwe
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.forename: Pascal
authors.initials: P
authors.lastname: Vranckx
authors.forename: Hector
authors.initials: H
authors.lastname: Garcia-Garcia
authors.forename: Roberto
authors.initials: R
authors.lastname: Diletti
authors.forename: Arie Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.forename: Marie Angèle
authors.initials: MA
authors.lastname: Morel
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: Valgimigli
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D002423:Cause of Death; D002986:Clinical Trials as Topic; D003331:Coronary Vessels / Q000033:anatomy & histology*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008954:Models, Biological; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization / Q000401:mortality / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D015607:Stents / Q000706:statistics & numerical data; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D003404:Creatinine