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Chichareon P, van Klaveren D, Modolo R, Kogame N, Takahashi K, Chang CC, Tomaniak M, Yuan J, Xie L, Song Y, Qiao S, Yang Y, Guan C, Zurakowski A, van Geuns RJ, Sabate M, Ong PJ, Wykrzykowska JJ, Piek JJ, Garg S, Hamm C, Steg G, Vranckx P, Valgimigli M, Windecker S, Juni P, Onuma Y, Steyerberg E, Xu B, Serruys PW. Predicting 2-year all-cause mortality after contemporary PCI: Updating the logistic clinical SYNTAX score. Catheter Cardiovasc Interv 2021; 98:1287-1297. [PMID: 33539048 DOI: 10.1002/ccd.29490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/02/2020] [Accepted: 12/27/2020] [Indexed: 01/04/2023]
Abstract
AIMS We aimed to update the logistic clinical SYNTAX score to predict 2 year all-cause mortality after contemporary percutaneous coronary intervention (PCI). METHODS AND RESULTS We analyzed 15,883 patients in the GLOBAL LEADERS study who underwent PCI. The logistic clinical SYNTAX model was updated after imputing missing values by refitting the original model (refitted original model) and fitting an extended new model (new model, with, selection based on the Akaike Information Criterion). External validation was performed in 10,100 patients having PCI at Fu Wai hospital. Chronic obstructive pulmonary disease, prior stroke, current smoker, hemoglobin level, and white blood cell count were identified as additional independent predictors of 2 year all-cause mortality and included into the new model. The c-indexes of the original, refitted original and the new model in the derivation cohort were 0.74 (95% CI 0.72-0.76), 0.75 (95% CI 0.73-0.77), and 0.78 (95% CI 0.76-0.80), respectively. The c-index of the new model was lower in the validation cohort than in the derivation cohort, but still showed improved discriminative ability of the newly developed model (0.72; 95% CI 0.67-0.77) compared to the refitted original model (0.69; 95% CI 0.64-0.74). The models overestimated the observed 2 year all-cause mortality of 1.11% in the Chinese external validation cohort by 0.54 percentage points, indicating the need for calibration of the model to the Chinese patient population. CONCLUSIONS The new model of the logistic clinical SYNTAX score better predicts 2 year all-cause mortality after PCI than the original model. The new model could guide clinical decision making by risk stratifying patients undergoing PCI.
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Affiliation(s)
- Ply Chichareon
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - David van Klaveren
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Rodrigo Modolo
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
| | - Norihiro Kogame
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kuniaki Takahashi
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Chun-Chin Chang
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mariusz Tomaniak
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Jinqing Yuan
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Lihua Xie
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Ying Song
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Shubin Qiao
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Yuejin Yang
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Changdong Guan
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Aleksander Zurakowski
- American Heart of Poland, Center for Cardiovascular Research and Development, Katowice, Poland
| | - Robert-Jan van Geuns
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manel Sabate
- University Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Paul J Ong
- Tan Tock Seng Hospital, Novena, Singapore
| | - Joanna J Wykrzykowska
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan J Piek
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Christian Hamm
- Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany
| | - Gabriel Steg
- FACT, French Alliance for Cardiovascular Trials; Hôpital Bichat, AP-HP, Université Paris-Diderot; and INSERM U-1148, all in Paris, Paris, France.,Royal Brompton Hospital, Imperial College, London, UK
| | - Pascal Vranckx
- Hartcentrum Hasselt, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Peter Juni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Canada
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Ewout Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bo Xu
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland.,NHLI, Imperial College London, London, UK
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Serruys PW, Chichareon P, Modolo R, Leaman DM, Reiber JH, Emanuelsson H, Di Mario C, Pijls NH, Morel MA, Valgimigli M, Farooq V, van Klaveren D, Capodanno D, Andreini D, Bourantas CV, Davies J, Banning AP, Escaned J, Piek JJ, Echavarría-Pinto M, Taylor CA, Thomsen B, Collet C, Pompilio G, Bartorelli AL, Glocker B, Dressler O, Stone GW, Onuma Y. The SYNTAX score on its way out or … towards artificial intelligence: part I. EUROINTERVENTION 2020; 16:44-59. [DOI: 10.4244/eij-d-19-00543a] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Serruys PW, Chichareon P, Modolo R, Leaman DM, Reiber JH, Emanuelsson H, Di Mario C, Pijls NH, Morel MA, Valgimigli M, Farooq V, van Klaveren D, Capodanno D, Andreini D, Bourantas CV, Davies J, Banning AP, Escaned J, Piek JJ, Echavarría-Pinto M, Taylor CA, Thomsen B, Collet C, Pompilio G, Bartorelli AL, Glocker B, Dressler O, Stone GW, Onuma Y. The SYNTAX score on its way out or … towards artificial intelligence: part II. EUROINTERVENTION 2020; 16:60-75. [DOI: 10.4244/eij-d-19-00543b] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ermis E, Yildirim E, Ucar H, Allahverdiyev S, Teskin O, Teker ME, Ereren E, Cengiz M. The Association Between SYNTAX Score II and Carotid Artery Disease Severity in Patients Who Underwent Coronary Artery Bypass Grafting. Angiology 2019; 71:56-61. [DOI: 10.1177/0003319719868360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The SYNTAX score (SS) and SS II, which include additional clinical parameters, are widely used today for deciding revascularization following coronary angiography. We investigated the association between the presence and severity of carotid artery disease (CrAD) using the SS and SS II in 287 patients who underwent coronary artery bypass grafting. We based this investigation on the known association between coronary artery disease and CrAD. A significant association was observed between the groups with and without CrAD in terms of SS II values (28.4 ± 9.6 vs 21.4 ± 7.7, respectively; P < .001). A significant difference was also observed when stenosis was classified according to severity as <50%, 50% to 70%, and >70% ( P < .001). The results indicated a positive correlation between the presence and severity of CrAD as SS II increased ( r = 0.187, P = .005). According to the results of multivariate logistic regression analysis, the SS II was an independent predictor of CrAD.
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Affiliation(s)
- Emrah Ermis
- Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Erkan Yildirim
- Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Hakan Ucar
- Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Samir Allahverdiyev
- Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Onder Teskin
- Department of Cardiovascular Surgery, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Melike Elif Teker
- Department of Cardiovascular Surgery, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Emrah Ereren
- Department of Cardiovascular Surgery, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Mahir Cengiz
- Department of Internal Medicine, Faculty of Medicine, Biruni University, Istanbul, Turkey
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