Predicting 3-year mortality after percutaneous coronary intervention: updated logistic clinical SYNTAX score based on patient-level data from 7 contemporary stent trials.
OBJECTIVE
This study aimed to update the Logistic Clinical SYNTAX score to predict 3-year survival after percutaneous coronary intervention (PCI) and compare the performance with the SYNTAX score alone.


BACKGROUND
The SYNTAX score is a well-established angiographic tool to predict long-term outcomes after PCI. The Logistic Clinical SYNTAX score, developed by combining clinical variables with the anatomic SYNTAX score, has been shown to perform better than the SYNTAX score alone in predicting 1-year outcomes after PCI. However, the ability of this score to predict long-term survival is unknown.


METHODS
Patient-level data (N = 6,304, 399 deaths within 3 years) from 7 contemporary PCI trials were analyzed. We revised the overall risk and the predictor effects in the core model (SYNTAX score, age, creatinine clearance, and left ventricular ejection fraction) using Cox regression analysis to predict mortality at 3 years. We also updated the extended model by combining the core model with additional independent predictors of 3-year mortality (i.e., diabetes mellitus, peripheral vascular disease, and body mass index).


RESULTS
The revised Logistic Clinical SYNTAX models showed better discriminative ability than the anatomic SYNTAX score for the prediction of 3-year mortality after PCI (c-index: SYNTAX score, 0.61; core model, 0.71; and extended model, 0.73 in a cross-validation procedure). The extended model in particular performed better in differentiating low- and intermediate-risk groups.


CONCLUSIONS
Risk scores combining clinical characteristics with the anatomic SYNTAX score substantially better predict 3-year mortality than the SYNTAX score alone and should be used for long-term risk stratification of patients undergoing PCI.
Department of Interventional Cardiology, Thoraxcenter, Rotterdam, the Netherlands; Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom.
Javaid
J
Iqbal
Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
Yvonne
Y
Vergouwe
Department of Interventional Cardiology, Thoraxcenter, Rotterdam, the Netherlands.
Christos V
CV
Bourantas
David
D
van Klaveren
Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
David V
DV
Klaveren
Department of Interventional Cardiology, Thoraxcenter, Rotterdam, the Netherlands.
Yao-Jun
YJ
Zhang
Department of Interventional Cardiology, Thoraxcenter, Rotterdam, the Netherlands.
Carlos M
CM
Campos
Cardialysis, Rotterdam, the Netherlands.
Hector M
HM
García-García
Cardialysis, Rotterdam, the Netherlands.
Marie-Angele
MA
Morel
Department of Interventional Cardiology, Thoraxcenter, Rotterdam, the Netherlands.
Marco
M
Valgimigli
Cardiology Department, Bern University Hospital, Bern, Switzerland.
Stephan
S
Windecker
Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom.
Ewout W
EW
Steyerberg
Department of Interventional Cardiology, Thoraxcenter, Rotterdam, the Netherlands; Department of Cardiology, Imperial College London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com.
Patrick W
PW
Serruys
D000368:Aged; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
SYNTAX score; logistic clinical SYNTAX score; percutaneous coronary intervention; risk stratification