title: Prognostic utility of the SYNTAX score in patients with single versus multivessel disease undergoing percutaneous coronary intervention (from the Acute Catheterization and Urgent Intervention Triage StrategY [ACUITY] trial).
abstract: The SYNergy between percutaneous intervention with TAXus drug-eluting stents and cardiac surgery (SYNTAX) score (SS) is an effective angiographic predictor of clinical outcomes in patients with multivessel coronary artery disease (MVD) undergoing percutaneous coronary intervention. It is not known whether this relation is independent of the number of diseased vessels. The aim of the present study was to assess the relation between the SS and major adverse cardiac events (MACE) in patients with single-vessel disease (SVD) and MVD undergoing percutaneous coronary intervention. In the ACUITY trial, the SS was determined in 2,627 patients undergoing percutaneous coronary intervention. The relation between the SS and the 1-year clinical outcomes was assessed according to SS tertiles: <5 (n = 441), ≥5 but <10 (n = 525), and ≥10 (n = 495) for SVD and <10 (n = 361), ≥10 but <18 (n = 401), and ≥18 (n = 404) for MVD. At 1 year of follow-up, the rate of MACE was 16.8%, 24.7%, and 23.7% for patients with MVD in the first, second and third tertiles, respectively (p = 0.02). The corresponding rates for those with SVD was 13.3%, 15.3%, and 19.1% (p = 0.01). In the patients with MVD, the SS independently predicted 1-year MACE (hazard ratio 1.02, 95% confidence interval 1.01 to 1.03; p = 0.002), myocardial infarction (hazard ratio 1.02, 95% confidence 1.00 to 1.04; p = 0.02), and cardiac death (hazard ratio 1.05, 95% confidence interval 1.02 to 1.09; p = 0.005). In patients with SVD, the SS independently predicted 1-year MACE (hazard ratio 1.03, 95% confidence interval 1.01 to 1.05; p = 0.0009) and myocardial infarction (hazard ratio 1.05, 95% confidence interval 1.02 to 1.07; p = 0.002). In the overall study cohort, the SS was an independent predictor of MACE and death, and MVD (vs SVD) was not. In conclusion, the SS is a useful angiographic predictive tool for patients with SVD and MVD.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: Istituto Cardiologia, Policlinico S. Orsola, Bologna, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.affiliation: Mount Sinai Medical Center, New York, New York.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Mount Sinai Medical Center, New York, New York.
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: Weill Cornel Medical College, New York, New York.
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York. Electronic address: gstone@crf.org.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014218:Triage / Q000706:statistics & numerical data*