title: Risk stratification of patients undergoing medical therapy after coronary angiography.
abstract: We sought to investigate the prognostic impact of the SYNTAX (Synergy between PCI with TAXUS and Cardiac Surgery) score (SS) on 1-year clinical outcomes in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) undergoing medical therapy only.
  
  
  
  Among the 13 819 patients enrolled in the ACUITY trial and undergoing coronary angiogram, 4491 patients were treated with medical therapy as the initial strategy. Of those, baseline SS and complete angiographic analysis were available in 1275 patients. Patients were divided in four groups based on the presence or absence of coronary artery disease (CAD) and subsequently, among patients with CAD, by SS. Major adverse cardiac events (MACE) and its individual components (death, myocardial infarction, and unplanned revascularization) were compared between groups. Among the 1275 patients, the mean SS was 3.5 ± 7.0 (range 0-45). SYNTAX score was 0 in 842 patients, >0 and ≤5 in 170, >5 and ≤11 in 119, and >11 in 144 patients. The 1-year rates of MACE were higher in patients with CAD and higher SS. By multivariable analysis, the SS was a strong predictor of all adverse ischaemic events, including mortality. By receiver operator characteristic analysis, an SS cut-off of 8 showed the best prognostic accuracy for death and MACE.
  
  
  
  In patients with NSTE ACS undergoing medical therapy, the SS, especially when >8, was shown to be a strong predictor of 1-year MACE, including mortality. This finding has important clinical implications for risk stratification of patients with NSTE ACS undergoing medical therapy after an initial angiogram.
authors.affiliation: NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.|Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY, USA.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bettinger
authors.affiliation: Istituto di Cardiologia, Policlinico S. Orsola, University of Bologna, Bologna, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.affiliation: Hospital Israelita Albert Einstein and Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
authors.affiliation: Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY, USA.
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Dressler
authors.affiliation: Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Litherland
authors.affiliation: Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY, USA.
authors.forename: Dominic P
authors.initials: DP
authors.lastname: Francese
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Giustino
authors.affiliation: Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY, USA.|Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.|Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY, USA.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.|Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY, USA.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA pgenereux@crf.org.|Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY, USA.|Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, QC, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
mesh_terms: D054058:Acute Coronary Syndrome; D017023:Coronary Angiography; D003324:Coronary Artery Disease; D006801:Humans; D018570:Risk Assessment; D012307:Risk Factors
keywords: Medical therapy; Non-ST-elevation acute coronary syndromes; SYNTAX score