title: Usefulness of the logistic clinical SYNTAX score for predicting 1-year mortality in patients undergoing percutaneous coronary intervention of the left main coronary artery.
abstract: OBJECTIVE
  To externally validate the logistic clinical SYNTAX in patients undergoing percutaneous coronary intervention (PCI) of the left main coronary artery (LMCA).
  
  
  BACKGROUND
  A novel version of the clinical SYNTAX score (CSS) has been recently introduced to overcome the limitations of categorical risk scores for PCI by the incorporation of clinical variables and the SYNTAX score (SXscore) into a logistic formula for predicting 1-year mortality.
  
  
  METHODS
  Core and extended models of the logistic CSS (logCSS(core) and logCSS(ext)) were applied to 400 patients undergoing LMCA PCI, and their performance was compared with those of the standard CSS, SXscore, and age, creatinine, and ejection fraction (ACEF) score by different measures of discrimination and calibration.
  
  
  RESULTS
  A significant gradient in the distribution of 1-year mortality was noted with all the models (P < 0.001), with the SYNTAX and ACEF scores showing the lowest (0.64) and the highest (0.75) c-statistic, respectively. Based on Somers' D(xy) rank correlation, discrimination of both the logCSS(core) and the logCSS(ext) was numerically lower than that of the ACEF score. The logCSS(core) was miscalibrated toward underpredicting all-cause mortality in low-predicted probabilities, while the logCSS(ext) tended to underpredict in low-predicted probabilities and overpredict in high-predicted probabilities. Slope and intercept values reflected a better calibration ability of the logCSS(core) compared with the logCSS(ext). The global accuracy of the logCSS(core) was superior to that of the logCSS(ext) (Brier score 0.087 vs. 0.095).
  
  
  CONCLUSIONS
  A personalized approach to risk stratification of LMCA PCI with the logistic CSS is feasible and of potential clinical utility. However, in this study, the logistic CSS did not achieve superior discrimination compared with other categorical models, and suffered from mild to moderate miscalibration.
authors.affiliation: Department of Cardiovascular, Ferrarotto Hospital, University of Catania, Catania, Italy; ETNA Foundation, Catania, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Daniele
authors.initials: D
authors.lastname: Giacoppo
authors.forename: Fabio
authors.initials: F
authors.lastname: Dipasqua
authors.forename: Eligio
authors.initials: E
authors.lastname: Miccichè
authors.forename: Carmelo
authors.initials: C
authors.lastname: Licitra
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Di Salvo
authors.forename: Bruno
authors.initials: B
authors.lastname: Francaviglia
authors.forename: Carmelo
authors.initials: C
authors.lastname: Grasso
authors.forename: Alessio
authors.initials: A
authors.lastname: La Manna
authors.forename: Carmelo
authors.initials: C
authors.lastname: Sgroi
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
mesh_terms: D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D003661:Decision Support Techniques; D006801:Humans; D016015:Logistic Models; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: logistic clinical SYNTAX score; percutaneous coronary intervention; risk stratification