title: The SYNTAX Score Does Not Predict Risk of Adverse Events in Patients With Non-ST Elevation Acute Coronary Syndrome Who Undergo Coronary Artery Bypass Graft Surgery.
abstract: OBJECTIVE
  We tested the ability of the SYNTAX score (SS) to predict 1-year adverse outcomes for patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS) who undergo coronary artery bypass graft (CABG) surgery.
  
  
  BACKGROUND
  The SS effectively risk stratifies patients who undergo percutaneous coronary intervention, but not patients with stable coronary disease who undergo CABG.
  
  
  METHODS
  We calculated the SS for 457 patients with NSTE-ACS in the angiographic substudy of the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial who underwent CABG. We stratified and compared patients according to SS tertiles. We tested the ability of the SS, as a linear covariate, to predict adverse events by univariate analyses and by univariate and multivariable Cox proportional hazards model. We also tested the predictive abilities of the Age, Creatinine Clearance, and Ejection Fraction (ACEF) score, the clinical SS, and the logistic clinical SS.
  
  
  RESULTS
  The median SS was 23 (interquartile range, 15-30). Baseline clinical characteristics were similar among the groups. One-year mortality and major adverse cardiovascular events (all-cause death, myocardial infarction, any stroke, or urgent revascularization) were similar between the groups (P=.13 and P=.62, respectively). Receiver operating characteristic curves, net reclassification indices, and integrated discrimination indices did not improve with SS, clinical SS, or logistic clinical SS compared with the ACEF score.
  
  
  CONCLUSIONS
  The anatomical SS does not appear to be useful in risk stratifying patients with NSTE-ACS who undergo CABG. Clinical variables may better risk stratify patients with complex coronary artery disease considered for CABG.
authors.forename: Björn
authors.initials: B
authors.lastname: Redfors
authors.forename: Chun-Hui
authors.initials: CH
authors.lastname: He
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
authors.forename: Gennaro
authors.initials: G
authors.lastname: Giustino
authors.forename: Girma Minalu
authors.initials: GM
authors.lastname: Ayele
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019 USA. pgenereux@crf.org.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology