title: Angiographic score assessment improves cardiovascular risk prediction: the clinical value of SYNTAX and Gensini application.
abstract: BACKGROUND
  Severity of coronary artery disease (CAD) is related to cardiovascular outcome. We aimed to assess the long-term follow-up depending on Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) and Gensini score for prognosis. Both scores increase with complexity and thus reflect risk of cardiovascular events.
  
  
  RESULTS
  We determined complexity and extent of CAD by the SYNTAX and Gensini score in the AtheroGene cohort (N = 1,974, with 22.6 % women). The endpoint was non-fatal myocardial infarction (N = 132) and cardiovascular death (N = 159) over a median follow-up of 5.4 (Q1: 5.23/Q3: 5.57) years up to 8 years maximum (follow-up rate 99.4%). For SYNTAX score, the following distribution was used: low (≤22, N = 1,404), medium (23-32, N = 314), high score (>32, N = 256). Gensini score was split into thirds. Cox regression analysis showed a hazard ratio (HR) of 1.5 (95% confidence interval 1.16-1.95; p = 0.0024) for the log transformed SYNTAX score in a fully adjusted model and a HR of 1.41 (95% CI 1.13-1.77; p = 0.0025) for the Gensini score. The SYNTAX score alone had a C-index of 0.62, whereas adding clinical variables increased the C-index to 0.67. Similar results were obtained for the Gensini score. Regarding the SYNTAX score using net reclassification index, discrimination of events and non-events was enhanced by 37.2% in a model of clinical variables and biomarkers and by 31.8% for the Gensini score.
  
  
  CONCLUSIONS
  The SYNTAX and Gensini score in combination with clinical variables could be used to predict the cardiovascular prognosis during a long-term follow-up of up to 8 years in CAD patients.
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Sinning
authors.forename: Lars
authors.initials: L
authors.lastname: Lillpopp
authors.forename: Sebastian
authors.initials: S
authors.lastname: Appelbaum
authors.forename: Francisco
authors.initials: F
authors.lastname: Ojeda
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.forename: Renate
authors.initials: R
authors.lastname: Schnabel
authors.forename: Edith
authors.initials: E
authors.lastname: Lubos
authors.forename: Annika
authors.initials: A
authors.lastname: Jagodzinski
authors.forename: Till
authors.initials: T
authors.lastname: Keller
authors.forename: Thomas
authors.initials: T
authors.lastname: Munzel
authors.forename: Christoph
authors.initials: C
authors.lastname: Bickel
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012306:Risk; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors