title: Incremental prognostic value of the SYNTAX score to late gadolinium-enhanced magnetic resonance images for patients with stable coronary artery disease.
abstract: The prognostic significance of the SYNTAX (Synergy between PCI with Taxus and cardiac surgery) score has recently been demonstrated in patients with stable multivessel or left main coronary artery disease (CAD). The present study determines whether adding the SYNTAX score to Framingham risk score (FRS), left ventricular ejection fraction (LVEF) and presence of myocardial infarction (MI) by late gadolinium enhancement (LGE) magnetic resonance imaging can improve the risk stratification in patients with stable CAD. We calculated the SYNTAX score in 161 patients with stable CAD (mean age: 66 ± 10 years old). During a mean follow-up of 2.3 years, 56 (35 %) of 161 patients developed cardiovascular events defined as cardiovascular death, non-fatal MI, cerebral infarction, unstable angina pectoris, hospitalization due to heart failure and revascularization. Multivariate Cox regression analysis selected triglycerides [hazard ratio (HR): 1.005 (95 % confidence interval (CI): 1.001-1.008), p < 0.008], presence of LGE [HR: 6.329 (95 % CI: 2.662-15.05), p < 0.001] and the SYNTAX score [HR: 1.085 (95 % CI: 1.044-1.127), p < 0.001] as risk factors for future cardiovascular events. Adding the SYNTAX score to FRS, EF and LGE significantly improved the net reclassification index (NRI) [40.4 % (95 % CI: 18.1-54.8 %), p < 0.05] with an increase in C-statistics of 0.089 (from 0.707 to 0.796). An increase in C-statistics and significant improvement of NRI showed that adding the SYNTAX score to the FRS, LVEF and LGE incrementally improved risk stratification in patient with stable CAD.
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan. shingo.m12226@gmail.com.
authors.forename: Shingo
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan.
authors.forename: Naka
authors.initials: N
authors.lastname: Saito
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan.
authors.forename: Hidekuni
authors.initials: H
authors.lastname: Kirigaya
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Gyotoku
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Iinuma
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kusakawa
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Iguchi
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakachi
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Fukui
authors.affiliation: Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Futaki
authors.affiliation: Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
authors.forename: Tae
authors.initials: T
authors.lastname: Iwasawa
authors.affiliation: Department of Biostatistics and Epidemiology, Yokohama City University, Yokohama, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Taguri
authors.affiliation: Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University Hospital, Yokohama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D020520:Brain Infarction / Q000209:etiology; D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage*; D006333:Heart Failure / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D014280:Triglycerides / Q000097:blood; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D014280:Triglycerides; D019786:Gadolinium DTPA
keywords: Coronary artery disease; Late gadolinium enhancement; Magnetic resonance imaging; Prognosis; The SYNTAX score