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Prognostic Value of SYNTAX Score II in Patients with Acute Coronary Syndromes Referred for Invasive Management: A Subanalysis from the SPUM and COMFORTABLE AMI Cohorts


Obeid, Slayman; Frangieh, Antonio H; Räber, Lorenz; Yousif, Nooraldaem; Gilhofer, Thomas; Yamaji, Kyohei; Jaguszewski, Milosz; Aghlmandi, Soheila; Adams, James; Bockhorn, Yannik; Templin, Christian; Stähli, Barbara E; Jüni, Peter; Rodondi, Nicolas; Mach, François; Roffi, Marco; Windecker, Stephan; Maier, Willibald; Nietlispach, Fabian; Matter, Christian M; Klingenberg, Roland; Lüscher, Thomas F (2018). Prognostic Value of SYNTAX Score II in Patients with Acute Coronary Syndromes Referred for Invasive Management: A Subanalysis from the SPUM and COMFORTABLE AMI Cohorts. Cardiology Research and Practice, 2018:9762176.

Abstract

Aims
To assess the incremental prognostic value of SYNTAX score II (SxSII) as compared to anatomical SYNTAX Score (SxS) and GRACE risk score in patients with acute coronary syndromes who underwent percutaneous coronary intervention.
Methods and results
SxSII and SxS were determined in 734 ACS patients. Patients were enrolled in the prospective Special Program University Medicine ACS and the COMFORTABLE AMI cohorts and later on stratified according to tertiles of SxSII (SxSII ≤21.5 (=245), SxSII 21.5-30.6 (=245), and SxSII ≥30.6 (=244). The primary endpoint of adjudicated all-cause mortality and secondary endpoints of MACE (cardiac death, repeat revascularization, and myocardial infarction) and MACCE (all-cause mortality, cerebrovascular events, MI, and repeat revascularization) were determined at 1-year follow-up. SxSII provided incremental predictive information for risk stratification when compared to SxS and GRACE risk score (AUC 0.804, 95% CI 0.77-0.84, < 0.001 versus 0.67, 95% CI 0.63-0.72, =0.007 versus 0.69, 95% CI 0.6-0.8, =0.002), respectively. In a multivariable Cox regression analysis, we found that unlike SxS (adjusted HR 1.013, 95% CI (0.96-1.07), =0.654), SxSII was significantly associated with all-cause mortality (HR = 1.095, 95% CI (1.06-1.11), < 0.001). This was also true for the prediction of both secondary outcomes MACE (=60) and MACCE (=70) with an adjusted HR = 1.055, 95% CI (1.03-1.08), < 0.001, and HR = 1.065, 95% CI (1.04-1.09), < 0.001.
Conclusion
In patients with ACS who underwent PCI, SxSII is an independent predictor of mortality during 1-year follow-up. SxSII shows superiority in discriminating risk compared to conventional SxS and GRACE for all-cause mortality.

Abstract

Aims
To assess the incremental prognostic value of SYNTAX score II (SxSII) as compared to anatomical SYNTAX Score (SxS) and GRACE risk score in patients with acute coronary syndromes who underwent percutaneous coronary intervention.
Methods and results
SxSII and SxS were determined in 734 ACS patients. Patients were enrolled in the prospective Special Program University Medicine ACS and the COMFORTABLE AMI cohorts and later on stratified according to tertiles of SxSII (SxSII ≤21.5 (=245), SxSII 21.5-30.6 (=245), and SxSII ≥30.6 (=244). The primary endpoint of adjudicated all-cause mortality and secondary endpoints of MACE (cardiac death, repeat revascularization, and myocardial infarction) and MACCE (all-cause mortality, cerebrovascular events, MI, and repeat revascularization) were determined at 1-year follow-up. SxSII provided incremental predictive information for risk stratification when compared to SxS and GRACE risk score (AUC 0.804, 95% CI 0.77-0.84, < 0.001 versus 0.67, 95% CI 0.63-0.72, =0.007 versus 0.69, 95% CI 0.6-0.8, =0.002), respectively. In a multivariable Cox regression analysis, we found that unlike SxS (adjusted HR 1.013, 95% CI (0.96-1.07), =0.654), SxSII was significantly associated with all-cause mortality (HR = 1.095, 95% CI (1.06-1.11), < 0.001). This was also true for the prediction of both secondary outcomes MACE (=60) and MACCE (=70) with an adjusted HR = 1.055, 95% CI (1.03-1.08), < 0.001, and HR = 1.065, 95% CI (1.04-1.09), < 0.001.
Conclusion
In patients with ACS who underwent PCI, SxSII is an independent predictor of mortality during 1-year follow-up. SxSII shows superiority in discriminating risk compared to conventional SxS and GRACE for all-cause mortality.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
04 Faculty of Medicine > Center for Molecular Cardiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:September 2018
Deposited On:22 Feb 2019 14:53
Last Modified:25 Sep 2019 00:08
Publisher:Hindawi Publishing Corporation
ISSN:2090-0597
OA Status:Gold
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1155/2018/9762176
PubMed ID:30356345

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