title: SYNTAX score II in patients with coronary artery disease undergoing percutaneous mitral repair with the MitraClip.
abstract: BACKGROUND
  Percutaneous mitral valve repair (PMVR) using the MitraClip™ system has become a valuable alternative in patients with severe mitral regurgitation (MR) and high surgical risk. We sought to evaluate the prognostic value of the SYNTAX II score (SSII) in patients with concomitant coronary artery disease (CAD) undergoing a Mitraclip procedure.
  
  
  METHODS
  In seventy-five consecutive patients who underwent PMVR at the University Heart Center Zürich and the Cardiocentro Ticino, the SSSII was calculated at baseline. Clinical endpoints comprised of all-cause mortality, mitral valve surgery due to failure of PMVR or reoperation, hospitalization for congestive heart failure, heart transplantation and the composite of all four endpoints.
  
  
  RESULTS
  Patients were followed for a median of 271days. And were divided in tertiles of SSII: SSII low ≤46.5 (n=25), SSII mid 46.6-54.4 (n=25) and SSII high ≥54.5 (n=25). Patients in the highest SSII tertile had a lower left ventricular ejection fraction (33% vs. 40% vs. 53%) with a higher log-BNP (3.6 vs. 3.45 vs. 3.16) when compared to SSII mid and SSII low, respectively. However, the anatomical syntax score (SS) did not differ significantly within the tertiles (9.1±6.3 (SSII Low) vs 9.5±7.6 (SSII Mid) vs 10.2±6.7(SSII High), p=0.837). The primary endpoint occurred in 33% of patients (n=25). By multivariate analysis patients in the high SSII tertile (OR=6.12, 95% confidence interval, [CI] 1.45-25.86, p=0.014) and patients with a history of MI (OR=3.57, 95% confidence interval, [CI] 1.17-10.88, p=0.025) were at significantly higher risk of experiencing adverse events. Furthermore, in a combined outcome ROC curve analysis, the SSII showed good discrimination with an AUC of 0.73, p=0.001. A cutoff SSII >49 has been identified to have a sensitivity of 83% and specificity of 53% with approximately 45% of the patients experiencing an event during follow-up.
  
  
  CONCLUSIONS
  Using SSII in CAD patients undergoing PMVR is feasible and of prognostic significance hence widening its clinical utility in valvular heart disease.
authors.affiliation: University Heart Center, University Hospital Zurich, Switzerland.
authors.forename: Slayman
authors.initials: S
authors.lastname: Obeid
authors.affiliation: University Heart Center, University Hospital Zurich, Switzerland.
authors.forename: Adrian
authors.initials: A
authors.lastname: Attinger-Toller
authors.affiliation: University Heart Center, University Hospital Zurich, Switzerland.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taramasso
authors.affiliation: Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pedrazzini
authors.affiliation: University Heart Center, University Hospital Zurich, Switzerland; HerzZentrum Hirslanden Zurich, Switzerland.
authors.forename: Gabor
authors.initials: G
authors.lastname: Suetsch
authors.affiliation: University Heart Center, University Hospital Zurich, Switzerland.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Landolt
authors.affiliation: University Heart Center, University Hospital Zurich, Switzerland.
authors.forename: Fatih
authors.initials: F
authors.lastname: Karbeyaz
authors.affiliation: University Heart Center, University Hospital Zurich, Switzerland.
authors.forename: Hector
authors.initials: H
authors.lastname: Rodriguez
authors.affiliation: Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sürder
authors.affiliation: Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.affiliation: University Heart Center, University Hospital Zurich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: University Heart Center, University Hospital Zurich, Switzerland. Electronic address: francesco.maisano@usz.ch.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013525:Surgical Instruments
keywords: Interventional cardiology; Mitraclip; Mitral valve regurgitation; Syntax score; Valvular disease