title: SYNTAX score predicts major bleeding following drug-eluting stent implantation in an all-comers population.
abstract: OBJECTIVE
  Previous studies have reported that coronary intervention for complex lesions is independently correlated with major bleeding. The SYNTAX score is an angiographic tool used to grade the complexity of coronary artery diseases. The aim of this study was to assess the ability of the SYNTAX score to predict major bleeding following drug-eluting stent implantation.
  
  
  METHODS
  We analyzed 722 patients who underwent drug-eluting stent implantation in an all-comers population between January 2007 and April 2010. The incidence of major bleeding and stent thrombosis was investigated during a 2-year period. Major bleeding was evaluated using the CRUSADE score and Bleeding Academic Research Consortium criteria. Patients were stratified into the following groups according to the SYNTAX trial: low (≤ 22; n=484), intermediate (23-32; n=128), and high (≥ 33; n=110).
  
  
  RESULTS
  Major bleeding was observed in 47 patients (6.5%) during the 2-year period, and there were 12 incidents of stent thrombosis (1.7%). Major bleeding rates for patients in the low, intermediate, and high SYNTAX score tertiles were 2.9%, 7.8%, and 20.9%, respectively (P < .0001). The SYNTAX score had an adjusted hazard ratio of 1.81 (95% confidence interval, 1.27-2.57) for 2-year major bleeding. The predictive value of the adjusted area under the receiver operating characteristic curve for major bleeding significantly improved after inclusion of the CRUSADE score (C statistic, 0.890 vs 0.812).
  
  
  CONCLUSIONS
  Although the SYNTAX score can predict major bleeding risk, the predictive value of the CRUSADE score was higher. These scores may be useful in clinical decision-making on revascularization strategies and on the optimal duration of dual antiplatelet therapy following drug-eluting stent implantation.
authors.affiliation: Division of Cardiovascular Medicine, Ohashi Hospital, Toho University Medical Center, Tokyo, Japan. Electronic address: raisuke@live.jp.
authors.forename: Raisuke
authors.initials: R
authors.lastname: Iijima
authors.affiliation: Division of Cardiovascular Medicine, Ohashi Hospital, Toho University Medical Center, Tokyo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Nagashima
authors.affiliation: Division of Cardiovascular Medicine, Ohashi Hospital, Toho University Medical Center, Tokyo, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Sato
authors.affiliation: Division of Cardiovascular Medicine, Ohashi Hospital, Toho University Medical Center, Tokyo, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Tokue
authors.affiliation: Division of Cardiovascular Medicine, Ohashi Hospital, Toho University Medical Center, Tokyo, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Araki
authors.affiliation: Division of Cardiovascular Medicine, Ohashi Hospital, Toho University Medical Center, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamazaki
authors.affiliation: Division of Cardiovascular Medicine, Ohashi Hospital, Toho University Medical Center, Tokyo, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Shiba
authors.affiliation: Division of Cardiovascular Medicine, Ohashi Hospital, Toho University Medical Center, Tokyo, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Hara
authors.affiliation: Division of Cardiovascular Medicine, Ohashi Hospital, Toho University Medical Center, Tokyo, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugi
authors.affiliation: Division of Cardiovascular Medicine, Ohashi Hospital, Toho University Medical Center, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: CRUSADE score; Drug-eluting stent; Dual antiplatelet therapy; Hemorragia mayor; Major bleeding; Puntuación CRUSADE; Puntuación SYNTAX; SYNTAX score; Stent liberador de fármaco; Tratamiento antiagregante plaquetario combinado doble