title: Comparison of six risk scores in patients with triple vessel coronary artery disease undergoing PCI: competing factors influence mortality, myocardial infarction, and target lesion revascularization.
abstract: OBJECTIVE
  To compare the discriminatory value of differing risk scores for predicting clinical outcomes following PCI in routine practice.
  
  
  BACKGROUND
  Various risk scores predict outcomes after PCI. However, these scores consider markedly different factors, from purely anatomical (SYNTAX risk score [SRS]) to purely clinical (ACEF, modified ACEF [ACEFmod], NCDR), while other scores combine both elements (Clinical SYNTAX score [CSS], NY State Risk Score [NYSRS]).
  
  
  METHODS
  Patients with triple vessel and/or LM disease with 12 month follow-up were studied from a single center PCI registry. Exclusion criteria included STEMI presentation, prior revascularization and shock. Clinical events at 12 months were compared to baseline risk scores, according to score tertiles and area under receiver-operating-characteristic curves (AUC).
  
  
  RESULTS
  We identified 584 eligible patients (69.8±12.3yrs, 405 males). All scores were predictive of mortality, with the SRS being least predictive (AUC=0.66). The most accurate scores for mortality were the CSS and ACEF (AUC=0.76 for both: P = 0.019 and 0.08 vs. SRS, respectively). For TLR, while the SRS trended toward being positively predictive (P = 0.075), several scores trended towards a negative association, which reached significance for the NCDR (P = 0.045). The SRS and CSS were the only scores predictive of MI (both P < 0.05). No score was particularly accurate for predicting MACE (death+MI+TLR), with AUCs ranging from 0.53 (NCDR) to 0.63 (SRS).
  
  
  CONCLUSIONS
  Competing factors influence mortality, MI and TLR after PCI. An increasing burden of comorbidities is associated with mortality, whereas anatomical complexity predicts MI. By combining these outcomes to predict MACE, all scores show reduced utility.
authors.affiliation: Cardiovascular Institute, Mount Sinai Medical Center, New York, New York.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Kovacic
authors.forename: Atul M
authors.initials: AM
authors.lastname: Limaye
authors.forename: Samantha
authors.initials: S
authors.lastname: Sartori
authors.forename: Paul
authors.initials: P
authors.lastname: Lee
authors.forename: Roshan
authors.initials: R
authors.lastname: Patel
authors.forename: Sweta
authors.initials: S
authors.lastname: Chandela
authors.forename: Biana
authors.initials: B
authors.lastname: Trost
authors.forename: Swathi
authors.initials: S
authors.lastname: Roy
authors.forename: Rafael
authors.initials: R
authors.lastname: Harari
authors.forename: Birju
authors.initials: B
authors.lastname: Narechania
authors.forename: Rucha
authors.initials: R
authors.lastname: Karajgikar
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kim
authors.forename: Prakash
authors.initials: P
authors.lastname: Krishnan
authors.forename: Pedro
authors.initials: P
authors.lastname: Moreno
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality*; D009519:New York City; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: atherosclerosis; coronary artery disease; risk score; stenting