title: Predictive Value of Combining the Ankle-Brachial Index and SYNTAX Score for the Prediction of Outcome After Percutaneous Coronary Intervention (from the SHINANO Registry).
abstract: The Synergy Between PCI With TAXUS and Cardiac Surgery (SYNTAX) score is effective in predicting clinical outcome after percutaneous coronary intervention (PCI). However, its prediction ability is low because it reflects only the coronary characterization. We assessed the predictive value of combining the ankle-brachial index (ABI) and SYNTAX score to predict clinical outcomes after PCI. The ABI-SYNTAX score was calculated for 1,197 patients recruited from the Shinshu Prospective Multi-center Analysis for Elderly Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention (SHINANO) registry, a prospective, observational, multicenter cohort study in Japan. The primary end points were major adverse cardiovascular and cerebrovascular events (MACE; all-cause death, myocardial infarction, and stroke) in the first year after PCI. The ABI-SYNTAX score was calculated by categorizing and summing up the ABI and SYNTAX scores. ABI ≤ 0.49 was defined as 4, 0.5 to 0.69 as 3, 0.7 to 0.89 as 2, 0.9 to 1.09 as 1, and 1.1 to 1.5 as 0; an SYNTAX score ≤ 22 was defined as 0, 23 to 32 as 1, and ≥ 33 as 2. Patients were divided into low (0), moderate (1 to 2), and high (3 to 6) groups. The MACE rate was significantly higher in the high ABI-SYNTAX score group than in the lower 2 groups (low: 4.6% vs moderate: 7.0% vs high: 13.9%, p = 0.002). Multivariate regression analysis found that ABI-SYNTAX score independently predicted MACE (hazards ratio 1.25, 95% confidence interval 1.02 to 1.52, p = 0.029). The respective C-statistic for the ABI-SYNTAX and SYNTAX score for 1-year MACE was 0.60 and 0.55, respectively. In conclusion, combining the ABI and SYNTAX scores improved the prediction of 1-year adverse ischemic events compared with the SYNTAX score alone.
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan. Electronic address: yasushi522@shinshu-u.ac.jp.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ueki
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miura
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Miyashita
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Motoki
authors.affiliation: Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Department of Cardiology, Matsumoto Kyoritsu Hospital, Matsumoto, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Cardiology, Saku Central Hospital, Saku, Japan.
authors.forename: Hikaru
authors.initials: H
authors.lastname: Kimura
authors.affiliation: Department of Cardiology, Iida Municipal Hospital, Iida, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Akanuma
authors.affiliation: Department of Cardiology, Saku Central Hospital, Saku, Japan.
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Mawatari
authors.affiliation: Department of Cardiology, Shinonoi General Hospital, Nagano, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Cardiology, Ina Central Hospital, Ina, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Hotta
authors.affiliation: Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kamiyoshi
authors.affiliation: Department of Cardiology, Shinonoi General Hospital, Nagano, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Maruyama
authors.affiliation: Department of Cardiology, Hokushin General Hospital, Nakano, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Komoro Kosei General Hospital, Komoro, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Eisawa
authors.affiliation: Department of Cardiology, Aizawa Hospital, Matsumoto, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Aso
authors.affiliation: Department of Cardiology, Azumino Red Cross Hospital, Azumino, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Uchikawa
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Hashizume
authors.affiliation: Department of Cardiology, Okaya Municipal Hospital, Okaya, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Sekimura
authors.affiliation: Department of Cardiology, Nagano Matsushiro General Hospital, Nagano, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ebisawa
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Izawa
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Koyama
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Uichi
authors.initials: U
authors.lastname: Ikeda
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome