A New Tool for the Risk Stratification of Patients With Complex Coronary Artery Disease

Abstract

on behalf of the ARTS-II InvestigatorsBackground-Presently, no effective risk model exists to predict long-term mortality or other major adverse cardiovascular and cerebrovascular events (MACCE) in those patients undergoing percutaneous coronary intervention (PCI). This study aimed to assess whether the Clinical SYNTAX Score (CSS) calculated by multiplying the SYNTAX Score to a modified ACEF score (age/ejection fraction ϩ1 for each 10 mL the creatinine clearance Ͻ60 mL/min per 1.73 m 2 ) would improve the ability of either score to predict mortality and MACCE. Methods and Results-The CSS was calculated in 512 patients enrolled in the ARTS-II study who had serum creatinine levels, ejection fraction, and body weight recorded at baseline. Clinical outcomes in terms of MACCE and mortality at 1-and 5-year follow-up were stratified according to CSS tertiles: CSS LOW Յ15.6 (nϭ170), 15.6ϽCSS MID Յ27.5 (nϭ171), and CSS HIGH Ͼ27.5 (nϭ171). At 1-year follow-up, rates of repeat revascularization and MACCE were significantly higher in the highest tertile group. At 5-year follow-up, CSS HIGH had a comparable rate of myocardial infarction, a trend toward a significantly higher rate of death, and significantly higher rates of repeat revascularization and overall MACCE compared with patients in the lower 2 tertiles. The respective C-statistics for the CSS, SYNTAX Score, and ACEF score for 5-year mortality were 0.69, 0.62, and 0.65 and for 5-year MACCE were 0.62, 0.59, and 0.57. Conclusions-An improvement in the ability of the SYNTAX Score to predict MACCE and mortality can be achieved by combining the SYNTAX Score with a simple clinical risk score incorporating age, ejection fraction, and creatinine clearance to produce the Clinical SYNTAX score. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00235170. (Circ Cardiovasc Interv. 2010;3:317-326.) Key Words: SYNTAX score Ⅲ complex coronary artery disease Ⅲ risk stratification C oronary artery bypass grafting (CABG) has historically been the preferred method of revascularization in patients with complex coronary artery disease (CAD); however, recent evidence indicates that in specific groups of patients, percutaneous coronary intervention (PCI) can offer a safe and suitable alternative. [1][2][3][4] This expanding use of PCI 5 has consequently increased the importance of developing a systematic approach for risk stratifying these complex patients so that they might receive the appropriate revascularization option. The ability to objectively decide which patients with complex CAD are suitable for PCI has gained new ground recently after the introduction of the SYNTAX Score. 6,7 Not only can this lesion-based scoring system quantify coronary anatomic complexity, but studies also demonstrate that it has a role in the short-and long-term risk stratification of patients undergoing PCI. 1,4,8 -11 Clinical Perspective on p 326One of the limitations of using the SYNTAX Score in this context is that lesion-based scoring systems have been shown to hav...

SYNTAX Score-II Predicts Long-Term Mortality in Patients Who Underwent Left Main Percutaneous Coronary Intervention Treated With Second-Generation Drug-Eluting Stents

“…1,[13][14][15][16][17][18] However, one of the most significant limitations of the SS is the omission of clinical variables in its calculation, which has been identified as a major effect in its capacity to accurately stratify patients with complex CAD. [19][20][21] The SS-II, by incorporating both the anatomic SS and clinical variables theoretically ensures a more accurate and individualized clinical outcome prediction. However, a limited number of studies have assessed the power of the SS-II.…”

Validation of SYNTAX and clinical SYNTAX scores in predicting atrial fibrillation following on-pump coronary artery bypass grafting

“…It was developed during the design of SYNTAX Trial in 2009 and numerous studies confirmed its clinical validity in predicting major cardiac events (MACEs) and mortality after PCI. [19] In addition, CSS which integrates SS with modified ACEF was defined by Garg et al [9] in 2010. In this study, CSS was found a better discriminatory ability for five-year mortality and MACE than either SS alone or modified ACEF score.…”

“…The modified ACEF score was calculated using the formula: age/ejection fraction + 1 point for every 10 mL/min reduction in CrCl <60 mL/min/1.73 m² (up to a maximum of 6 points). [9] …”

Percutaneous coronary intervention in the elderly: current updates and trends

“…The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score has been used to predict clinical outcomes in patients undergoing PCI especially those with LMCA lesions and/or multivessel coronary disease based on their lesions complexity [32] . More recently, this scoring system has been integrated with some independent clinical variables such as the patient's age, creatinine serum level, and left ventricular ejection fraction (LVEF) to obtain the clinical SYNTAX score (CSS) [33] . Both scoring systems have been shown to be valid in risk stratification and early mortality prediction among older patients with ACS undergoing PCI.…”