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Balcik M, Satar S, Gulen M, Acehan S, Sevdimbas S, Acele A, Sahin GK, Ince C, Aksay E, Yuksek A. BUN/albumin ratio predicts short-term mortality better than SYNTAX score in ST-elevation myocardial infarction patients. J Cardiovasc Med (Hagerstown) 2023; 24:326-333. [PMID: 37115970 DOI: 10.2459/jcm.0000000000001473] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE The aim of the study is to compare the prognostic power of the BUN/albumin ratio (BAR) calculated on admission to the emergency department and the SYNergy between Percutaneous Coronary Intervention with TAXus (SYNTAX) score calculated after coronary angiography (CAG) in predicting 30-day mortality in patients with ST-segment elevation myocardial infarction (STEMI). METHOD AND MATERIAL The study was conducted prospectively between March 2021 and March 2022 in the emergency department of a tertiary hospital. Patients over the age of 18 who underwent CAG with a diagnosis of STEMI were included in the study. Demographic charecteristics, comorbidities, laboratory parameters of the patients at the time of admission and SYNTAX (SX) score were recorded in the data form. RESULTS A total of 1147 patients (77% male) diagnosed with STEMI were included in the study. When the receiver-operating characteristic analysis for SX score and laboratory parameters' power to predict mortality was examined, it was found that the AUC value of the BAR level (AUC: 0.736; 95% confidence interval: 0.670-0.802, P < 0.001) was the highest. If the threshold value of the serum BAR level, which was determined to predict mortality, was taken as 4, the sensitivity was found to be 76.7% and the specificity was 56.9%. With multivariate logistic analysis, it was determined that the risk of mortality increased by 1.25 for each unit increase in the BAR value in STEMI patients ( P < 0.001). CONCLUSION According to the study data, the BAR may guide the clinician in the early period as a practical and valuable predictor of 30-day mortality in patients diagnosed with STEMI.
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Affiliation(s)
- Muhammet Balcik
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic
| | - Salim Satar
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic
| | - Muge Gulen
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic
| | - Selen Acehan
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic
| | - Sarper Sevdimbas
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic
| | - Armagan Acele
- Health Sciences University, Adana City Training and Research Hospital, Cardiology Clinic, Adana, Turkey
| | - Gonca Koksaldi Sahin
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic
| | - Cagdas Ince
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic
| | - Erdem Aksay
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic
| | - Ali Yuksek
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic
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Sevdımbas S, Satar S, Gulen M, Acehan S, Acele A, Koksaldı Sahin G, Aka Satar D. Blood urea nitrogen/albumin ratio on admission predicts mortality in patients with non ST segment elevation myocardial infarction. Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:454-460. [PMID: 36128642 DOI: 10.1080/00365513.2022.2122075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The aim of this study is to reveal the predictive power of biomarkers and SYNTAX (SX) score for short-term mortality in patients diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI) in the emergency department. This is prospective observational cohort study. Demographic characteristics of the patients, laboratory parameters on admission, left ventricular ejection fraction (LVEF) percentages, affected vessels in angiography (CAG) and the treatment strategy [medical therapy, percutaneous transluminal coronary angioplasty (PTCA), coronary angio by-pass graft] and SX scores were recorded on the data collection form. ROC curve was used to investigate the predictivity of blood urea nitrogen/albumin ratio (BAR), procalcitonin, C-reactive protein (CRP), high sensitivity cardiac troponin I (Hs-cTnI), CRP to serum albumin ratio (CAR), neutrophil to lymphocyte ratio (NLR) and SX scores in mortality. Multivariate analysis of biomarkers and SX score was performed to estimate the patients' 30-day mortality. Of the 415 patients were included in the study. ROC analysis of BAR, CAR, CRP, Procalcitonin, Hs-cTnI, NLR and SX score to predict mortality was statistically significant. BAR (OR: 1.280, 95% CI: 1.113-1.472, p = .001) and SX score (OR: 1.071, 95% CI: 1.018-1.126, p = .007) were found to be independent predictors of 30 days mortality. LVEF reduction, SX score, the number of affected vessels and the frequency of LMCA lesions increase were found to be statistically significant in patients with BAR ≥4.8. BAR, which can be calculated easily and quickly on admission to the emergency department and in clinical practice, may be used to predict mortality in patients with NSTEMI.
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Affiliation(s)
- Sarper Sevdımbas
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Salim Satar
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Muge Gulen
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Selen Acehan
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Armagan Acele
- Health Sciences University, Adana City Training and Research Hospital, Department of Cardiology, Adana, Turkey
| | - Gonca Koksaldı Sahin
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Deniz Aka Satar
- Health Sciences University, Adana City Training and Research Hospital, Assisted Reproduction Unit, Andrology Laboratory, Adana, Turkey
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Martins EB, Hueb W, Brown DL, Scudeler TL, Lima EG, Rezende PC, Soares PR, Garzillo CL, Filho JPPL, Batista DV, Ramires JAF, Filho RK. Surgical and percutaneous revascularization outcomes based on SYNTAX I, II, and residual scores: a long-term follow-up study. J Cardiothorac Surg 2021; 16:248. [PMID: 34479587 PMCID: PMC8418036 DOI: 10.1186/s13019-021-01616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this study was to evaluate the association of SYNTAX scores I, II, and residual with cardiovascular outcomes of patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and compare both procedures in a long-term follow-up. Methods This is a retrospective single-center study from the MASS registry at the Heart Institute of the University of São Paulo, Brazil in which 969 patients with stable coronary artery disease undergoing CABG (559) or PCI (410) were included. We assessed the SYNTAX scores I, II and residual in both interventions. Clinical endpoints were the first occurrence of a composite of overall death, myocardial infarction, stroke, or repeat revascularization (MACCE) and the total occurrence of each component of MACCE. Results In the CABG sample, SSI had a median of 23 (IQR 17–29.5), median SSII of 25.4 (IQR 19.2–32.8), and median rSS of 2 (IQR 0–6.5); in PCI SSI had a median of 14 (IQR 10–19.1), median SSII of 28.7 (IQR 23–34.2), and median rSS of 4.7 (IQR 0–9). Total of 174 events were documented and CABG patients had a lower rate of MACCE (15.6% vs. 21.2%; adjusted HR 1.98; 95% CI 1.13–3.47; P = 0.016) and repeat revascularization (3.8% vs. 11.5%; adjusted HR 4.35; CI 95% 1.74–10.85; P = 0.002) compared with PCI. No SYNTAX score tertile found a difference in death rate between procedures. In a multivariate analysis, the rSS was an independent predictor for MACCE (HR 1.04; 95% CI 1.01–1.06; P = 0.001). Regarding death, the only independent predictors were ejection fraction and renal function. Conclusion Surgical revascularization resulted in a more complete revascularization and lower rates of major cardiac or cerebrovascular events in a long-term follow-up. Also, grading the incompleteness of revascularization through the residual SYNTAX score identified a higher event rate, suggesting that complete revascularization is associated with a better prognosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01616-6.
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Affiliation(s)
- Eduardo Bello Martins
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Whady Hueb
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - David L Brown
- Washington University School of Medicine, St. Louis, MO, USA
| | - Thiago Luis Scudeler
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo Gomes Lima
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Paulo Cury Rezende
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Paulo Rogério Soares
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Cibele Larrosa Garzillo
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jaime Paula Pessoa Linhares Filho
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Daniel Valente Batista
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jose Antonio Franchini Ramires
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Roberto Kalil Filho
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Abizaid A, Campos CM, Guimarães PO, Costa JDR, Falcão BAA, Mangione F, Caixeta A, Lemos PA, de Brito FS, Cavalcante R, Bezerra CG, Cortes L, Ribeiro HB, de Souza FR, Huemer N, do Val RM, Caramelli B, Calderaro D, Lima FG, Hajjar LA, Mehran R, Filho RK. Patients with COVID-19 who experience a myocardial infarction have complex coronary morphology and high in-hospital mortality: Primary results of a nationwide angiographic study. Catheter Cardiovasc Interv 2021; 98:E370-E378. [PMID: 33904638 PMCID: PMC8239511 DOI: 10.1002/ccd.29709] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 01/19/2023]
Abstract
Objectives We aimed to explore angiographic patterns and in‐hospital outcomes of patients with concomitant coronavirus disease‐19 (COVID‐19) and myocardial infarction (MI). Background Patients with COVID‐19 may experience MI during the course of the viral infection. However, this association is currently poorly understood. Methods This is a multicenter prospective study of consecutive patients with concomitant COVID‐19 and MI who underwent coronary angiography. Quantitative and qualitative coronary angiography were analyzed by two observers in an independent core lab. Results A total of 152 patients were included, of whom 142 (93.4%) had COVID‐19 diagnosis confirmation. The median time between symptom onset and hospital admission was 5 (1–10) days. A total of 83 (54.6%) patients presented with ST‐elevation MI. The median angiographic Syntax score was 16 (9.0–25.3) and 69.0% had multi‐vessel disease. At least one complex lesion was found in 73.0% of patients, 51.3% had a thrombus containing lesion, and 57.9% had myocardial blush grades 0/1. The overall in‐hospital mortality was 23.7%. ST‐segment elevation MI presentation and baseline myocardial blush grades 0 or 1 were independently associated with a higher risk of death (HR 2.75, 95%CI 1.30–5.80 and HR 3.73, 95%CI 1.61–8.61, respectively). Conclusions Patients who have a MI in the context of ongoing COVID‐19 mostly present complex coronary morphologies, implying a background of prior atherosclerotic disease superimposed on a thrombotic milieu. The in‐hospital prognosis is poor with a markedly high mortality, prompting further investigation to better clarify this newly described condition.
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Affiliation(s)
- Alexandre Abizaid
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Hospital Sírio Libanês, Sao Paulo, Brazil.,Hospital do Coração (HCor), São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Instituto Prevent Senior, São Paulo, Brazil
| | - Patrícia O Guimarães
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - José de Ribamar Costa
- Hospital do Coração (HCor), São Paulo, Brazil.,Department of Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | - Breno A A Falcão
- Department of Cardiology, Hospital de Messejana, Fortaleza, Brazil
| | - Fernanda Mangione
- Department of Cardiology, Hospital Beneficência Portuguesa, Sao Paulo, Brazil
| | - Adriano Caixeta
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Pedro A Lemos
- Department of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Fabio S de Brito
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Hospital Sírio Libanês, Sao Paulo, Brazil.,Department of Cardiology, Hospital São Camilo, Sao Paulo, Brazil
| | | | | | - Leandro Cortes
- Department of Cardiology, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Henrique B Ribeiro
- Department of Cardiology, Hospital Samaritano Paulista, Sao Paulo, Brazil
| | - Francis R de Souza
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Natassja Huemer
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Renata M do Val
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Bruno Caramelli
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Daniela Calderaro
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Felipe G Lima
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ludhmila A Hajjar
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roberto Kalil Filho
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Hospital Sírio Libanês, Sao Paulo, Brazil
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The Impact of War-Related Stress on Coronary Artery Disease Severity in War Survivors: A SYNTAX Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063233. [PMID: 33800972 PMCID: PMC8004035 DOI: 10.3390/ijerph18063233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/13/2022]
Abstract
Background: Due to the strong relationship between stress and heart disease, particularly acute myocardial infarction (MI), this study investigated the complexity of coronary artery disease (CAD) among Syrian refugee patients referred to Jordan University Hospital and its relation to war-related stressors. Methods: This is a retrospective study that utilized the SYNTAX I score in order to evaluate all Syrian refugees that underwent coronary artery catheterization at Jordan University Hospital during the period between May of 2014 and December of 2017. Results: There was a significant association between war-related stressors and high SYNTAX score (SX score), thus indicating a higher complexity of CAD in Syrian war survivors with higher stress scores. The strongest war-related correlation was observed with crossing green-lines, in which Syrian refugee patients who had crossed such lines had significantly higher SYNTAX scores. Regression analysis demonstrated that war stressors were positive predictors of increased SYNTAX scores even when adjusted for conventional CAD risk factors. Surprisingly, none of the CAD risk factors were significantly associated with SYNTAX score. Conclusion: Our findings suggest that exposure to multiple war-related stressors may increase the complexity and severity of CAD in Syrian war survivors. Thus, special attention, efforts, and resources should be allocated to screen for such vulnerable patients in order to provide them with the appropriate healthcare.
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Acet H, Güzel T, Aslan B, Isik MA, Ertas F, Catalkaya S. Predictive Value of C-Reactive Protein to Albumin Ratio in ST-Segment Elevation Myocardial Infarction Patients Treated With Primary Percutaneous Coronary Intervention. Angiology 2020; 72:244-251. [PMID: 33371718 DOI: 10.1177/0003319720963697] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The present study aimed to examine the association of C-reactive protein to albumin ratio (CAR) with short-term major adverse cardiac events (MACEs) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). We included 539 STEMI patient treated with pPCI in this study. Patients were divided into 2 groups according to MACE development. Patients with MACE had higher CAR than those without (1.18 [0.29-1.99] vs 0.21 [0.09-0.49], P < .001). Multivariate analysis showed that The Global Record for Acute Coronary Events score, Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score, glucose and CAR (odds ratio:1.326, 95% CI: 1.212-1452, P < .001) were independent predictors of MACE. The CAR may be proven useful for risk stratification in STEMI patients undergoing pPCI.
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Affiliation(s)
- Halit Acet
- Department of Cardiology, Faculty of Medicine, 37507Dicle University, Diyarbakir, Turkey
| | - Tuncay Güzel
- Department of Cardiology, Akhisar State Hospital, Manisa, Turkey
| | - Bayram Aslan
- Department of Cardiology, Ergani State Hospital, Diyarbakir, Turkey
| | - Mehmet Ali Isik
- Department of Cardiology, 37507Mardin State Hospital, Mardin, Turkey
| | - Faruk Ertas
- Department of Cardiology, Faculty of Medicine, 37507Dicle University, Diyarbakir, Turkey
| | - Sibel Catalkaya
- Department of Cardiology, Edremit State Hospital, Edremit, Turkey
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Huang Z, Zhang H, Wang M, Yang W, Qiao S, Hu F. Revascularization Versus Medical Therapy in Takayasu's Arteritis Patients with Coronary Artery Involvement. Rheumatol Ther 2020; 8:119-133. [PMID: 33230786 PMCID: PMC7991006 DOI: 10.1007/s40744-020-00251-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/30/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Treatment strategies to improve clinical outcomes in Takayasu's arteritis (TA) with coronary lesions have ranged from pharmacological therapy to invasive procedures, such as coronary angioplasty, stenting, and surgery. However, the therapeutic strategy for this kind of patient is still unclear. This study aimed to investigate the clinical characteristics and influence of revascularization versus medical therapy in TA patients with coronary artery involvement. Methods We analyzed the medical records of 806 TA patients between January 2008 and December 2019. Clinical features and treatment were analyzed, and patients were categorized into medical treatment and revascularization. Additionally, patients were sorted as percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) based on the strategy of revascularization. Results Ninety cases with coronary lesions induced by TA were enrolled. Among 90 cases, 39 patients adopted conservative treatment, and 51 patients received revascularization (28 subjects with PCI, 23 participants with CABG). The median follow-up time was 63 (45–91) months. There is no significant difference in cardiovascular death between medical treatment and revascularization (2/39, 5.1% vs. 5/51, 9.8%, P = 0.971). The analysis of subgroup indicated that the mortality caused by cardiovascular disease was also similar in the CABG and PCI (2/28, 7.1% vs. 3/23, 13.0%, P = 0.772). However, the proportion of restenosis is much higher in the PCI compared with that of CABG (39.3%, 8.7%, P = 0.022, respectively). Heart failure is an independent predictor of death in these patients. Conclusions There is no significant difference in cardiovascular death between medical treatment and revascularization. The analysis of the subgroup indicated that the mortality caused by cardiovascular disease was also similar in the CABG and PCI, but the restenosis is much higher in the PCI compared with that of CABG. Heart failure is an independent predictor of death in these patients.
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Affiliation(s)
- Zhiwei Huang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Hongliang Zhang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Man Wang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Weixian Yang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Shubin Qiao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
| | - Fenghuan Hu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
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Song Y, Guan C, Cao X, Qin L, Li Y, Li Z, Nie S, Hou S, Zhang M, Gao R, Yuan J, Xu B. Validation of the long-term prognostic capability of the SYNTAX score II in patients undergoing biodegradable polymer-based Sirolimus-eluting stents: 2-year outcomes from the PANDA III trial. Int J Cardiol 2020; 309:27-32. [PMID: 32238273 DOI: 10.1016/j.ijcard.2020.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/10/2020] [Accepted: 02/14/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to assess the prognostic ability of SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) Score II (SS-II) in LM and/or TVD patients undergoing biodegradable polymer-based drug-eluting stents (BP-DES) in the multi-central randomized PANDA III trial. METHODS A total of 723 patients in PANDA III population were enrolled in this study. According to SS-II tertiles, patients were stratified as follow: SS-II ≤ 23 (n = 224), 23 < SS II ≤ 31 (n = 255), SS II > 31 (n = 244). The predictive abilities for 2-year cardiac death were compared between angiographic scores and scores combining both angiographic and clinical variables. RESULTS Mean anatomic SS was 20.6 ± 9.4, SS-II for PCI was 28.7 ± 8.6. During 2-year follow up, cardiac death (0.00% vs. 1.7% vs. 4.3%, p = 0.003) and target lesion failure (5.9% vs. 9.1% vs. 13.6%, p = 0.020) was significantly higher in the upper tertile group than in intermedian and low tertile. At multivariate analysis, SS-II for PCI was an independent risk factor of cardiac death (Hazard ratio: 2.41, 95%CI: 1.47-3.97, p < 0.005) and TLF (Hazard ratio: 1.29, 95%CI: 1.01-1.65, p = 0.040). The ROC curve analysis showed that SS-II for PCI had better ability than other SYNTAX scoring systems to predict cardiac death (AUC: 0.746, 95%CI:0.63-0.87, p = 0.010). CONCLUSIONS The SS-II had superiority than other SYNTAX scoring systems in predicting 2-year cardiac death in LM and/or TVD patients undergoing PCI with biodegradable polymer drug-eluting stents.
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Affiliation(s)
- Ying Song
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Changdong Guan
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuebin Cao
- Chinese PLA 252 Hospital, Baoding, China
| | - Lei Qin
- Kaifeng Central Hospital, Kaifeng, China
| | - Yi Li
- Yunnan St. John's Hospital, Kunming, China
| | - Zhanquan Li
- Liaoning Provincial People's Hospital, Shenyang, China
| | - Shaoping Nie
- Affiliated Anzhen Hospital of Capital Medical University, Beijing, China
| | - Shuang Hou
- China Cardiovascular Research Foundation Inc, Beijing, China
| | - Min Zhang
- China Cardiovascular Research Foundation Inc, Beijing, China
| | - Runlin Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinqing Yuan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
| | - Bo Xu
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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Wang H, Zhang Y, Shen Z, Fang L, Liu Z, Zhang S. Comparing the effects of different management strategies on long-term outcomes for significant coronary stenosis in patients with Takayasu arteritis. Int J Cardiol 2020; 306:1-7. [DOI: 10.1016/j.ijcard.2020.02.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/05/2020] [Accepted: 02/18/2020] [Indexed: 02/02/2023]
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10
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Ma X, Hou F, Tian J, Zhou Z, Ma Y, Cheng Y, Du Y, Shen H, Hu B, Wang Z, Liu Y, Zhao Y, Zhou Y. Aortic Arch Calcification Is a Strong Predictor of the Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7659239. [PMID: 31485445 PMCID: PMC6702823 DOI: 10.1155/2019/7659239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/30/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the correlation of the extent of aortic arch calcification (AAC) detectable on chest X-rays with the severity of coronary artery disease (CAD) as evaluated by the SYNTAX score (SS) in patients with acute coronary syndrome (ACS). METHODS A total of 1,418 patients (344 women; 59 ± 10 years) who underwent coronary angiography for ACS and were treated with coronary revascularization were included in the present study; chest X-rays were performed on admission. The AAC extent was divided into four grades (0-3). SS was calculated based on each patient's coronary angiographic findings. The relationship between the AAC extent and SS was assessed. RESULTS The AAC extent was positively correlated with SS (ρ = 0.639, P < 0.001). In the multivariate analysis, compared with grade 0, odds ratios (ORs) of AAC grades 1, 2, and 3 in predicting SS >22 were 12.95 (95% CI, 7.85-21.36), 191.76 (95% CI, 103.17-356.43), and 527.81 (95% CI, 198.24-1405.28), respectively. Receiver operating characteristic curve analysis yielded a strong predictive ability of the AAC extent for SS >22 (area under curve = 0.840, P < 0.001). Absence of AAC had a sensitivity, specificity, positive prognostic value, negative prognostic value, and accuracy of 46.7%, 95.9%, 94.1%, 56.4%, and 67.3%, respectively, for SS ≤22. AAC grades ≥2 had a sensitivity of 66.3%, specificity of 89.2%, positive prognostic value of 81.5%, negative prognostic value of 78.6%, and accuracy of 79.6% for the correct identification of SS >22. CONCLUSIONS The extent of AAC detectable on chest X-rays might provide valuable information in predicting CAD severity in ACS patients.
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Affiliation(s)
- Xiaoteng Ma
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Fangjie Hou
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao 266000, China
| | - Jing Tian
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yue Ma
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Yujing Cheng
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Yu Du
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Hua Shen
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Bin Hu
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Zhijian Wang
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Yuyang Liu
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Yingxin Zhao
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Yujie Zhou
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
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Jeong HC, Ahn JH, Kim MC, Sim DS, Park KH, Hong YJ, Kim JH, Jeong MH, Seung KB, Chang K, Ahn Y. A score for decision making during percutaneous coronary intervention in acute myocardial infarction patients with multivessel disease. Korean J Intern Med 2019; 34:324-334. [PMID: 29551055 PMCID: PMC6406104 DOI: 10.3904/kjim.2017.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 09/08/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND/AIMS The optimal percutaneous coronary intervention (PCI) strategy in patients with acute myocardial infarction (AMI) with multivessel disease (MVD) is uncertain. This study was designed to develop a novel and simple tool for assessing an individualized and optimized PCI strategy in AMI patients with MVD. METHODS In total, 5,025 patients with AMI from nine centers at two universities were enrolled in the prospective Convergent Registry of Catholic and Chonnam University for Acute Myocardial Infarction (COREA-AMI) registry from January 2004 through December 2009. From among them, we selected 2,630 patients with MVD who were treated by culprit-only or multivessel (MV) PCI. We investigated major adverse cardiac events (MACEs) during a 1-year clinical follow-up. Using a subgroup analysis, we extracted variables for use in the culprit only versus multivessel revascularization (CONVERSE) score, which showed a preference for MV PCI rather than culprit-only PCI for treating MVD. RESULTS The CONVERSE score was constructed using eight independent variables (1 point for each variable): age > 65 years, hypertension, diabetes mellitus, high Killip class (III or IV), low left ventricular ejection fraction (≤ 50%), low creatinine clearance (≤ 60 mL/min), high level of high-sensitivity C-reactive protein (≥ 2.0 mg/L), and left anterior descending artery or left main as the nonculprit vessel. The incidence of MACEs increased linearly with the CONVERSE score. The receiver operating characteristic curve showed that the cutoff value was 3 points. CONCLUSION The results suggest that patients with a CONVERSE score of 3 or more should undergo MV PCI.
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Affiliation(s)
- Hae Chang Jeong
- Department of Cardiology, Cardiovascular Center, Miraero 21 Hospital, Gwangju, Korea
| | - Joon Ho Ahn
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Keun Ho Park
- Department of Cardiology, Chosun University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ki-Bae Seung
- Department of Cardiology, Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kiyuk Chang
- Department of Cardiology, Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
- Correspondence to Youngkeun Ahn, M.D. Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-4764 Fax: +82-62-224-4764 E-mail:
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Lao Y, Feng L, Yuan Y, Zhang J, Huang X, Li M, Wu Z. Prognostic Value of Hemoglobin A1c Levels in Postmenopausal Diabetic Patients Undergoing Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome. Med Sci Monit 2018; 24:9399-9405. [PMID: 30587845 PMCID: PMC6322369 DOI: 10.12659/msm.912108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The purpose of our study was to analyze the clinical value of glycosylated hemoglobin Alc (HbA1c) levels in postmenopausal women with acute coronary syndrome (ACS) and diabetes following percutaneous coronary intervention (PCI). Material/Methods A total of 173 consecutive postmenopausal patients with comorbid diabetes underwent PCI for primary ACS were enrolled in this study. Serum HbA1c levels were measured prior to PCI, and baseline clinical characteristics of all patients were collected. All patients were followed up at regular intervals for major adverse cardiovascular events (MACEs) during the first year after PCI. MACEs included cardiac death, non-fatal myocardial infarction, and target vessel revascularization (TVR). Results At the endpoint of this study, 29 (16.8%) patients out of all 173 patients had MACEs. According to the effect of glycemic control (as indicated by HbA1c levels), all patients were stratified into a well-controlled group (HbA1c ≤7.0%, N=72) and a poorly-controlled group (HbA1c >7.0%, N=101). The incidence rate of MACEs and TVR in poorly-controlled diabetics was prominently higher than that in well-controlled diabetics (10.8% vs. 21.8%, p=0.04). In multivariable COX regression analysis, after adjustment for potential confounders, HbA1c ≥7.0% remained an independent risk predictor of MACE (HR, 2.17; 95%CI, 1.13–5.65; p<0.01). Conclusions In postmenopausal ACS patients with comorbid diabetes, a high level of HbA1c is associated with a higher MACE rate after PCI, which is mainly driven by a higher rate of TVR.
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Affiliation(s)
- Yi Lao
- Department of Cardiology, Zhong Shan Hospital of Sun Yat-sen University, Zhongshan, Guangdong, China (mainland)
| | - Li Feng
- Department of Cardiology, Zhong Shan Hospital of Sun Yat-sen University, Zhongshan, Guangdong, China (mainland)
| | - Yong Yuan
- Department of Cardiology, Zhong Shan Hospital of Sun Yat-sen University, Zhongshan, Guangdong, China (mainland)
| | - Jin Zhang
- Department of Cardiology, Zhong Shan Hospital of Sun Yat-sen University, Zhongshan, Guangdong, China (mainland)
| | - Xuansheng Huang
- Department of Cardiology, Zhong Shan Hospital of Sun Yat-sen University, Zhongshan, Guangdong, China (mainland)
| | - Mingxing Li
- Department of Cardiology, Zhong Shan Hospital of Sun Yat-sen University, Zhongshan, Guangdong, China (mainland)
| | - Zidi Wu
- Department of Cardiology, Zhong Shan Hospital of Sun Yat-sen University, Zhongshan, Guangdong, China (mainland)
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Alsancak Y, Sivri S, Baştuğ S, Bozkurt E. Role of calcium–albumin ratio in severity of coronary artery disease assessed by angiographic SYNTAX score. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.450950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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. Cardiol Res Pract 2018; 2018:9762176. [PMID: 30356345 PMCID: PMC6176297 DOI: 10.1155/2018/9762176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/12/2018] [Indexed: 11/17/2022] Open
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 (SxSIILow ≤21.5 (n=245), SxSIIMid 21.5–30.6 (n=245), and SxSIIHigh ≥30.6 (n=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, p < 0.001 versus 0.67, 95% CI 0.63–0.72, p=0.007 versus 0.69, 95% CI 0.6–0.8, p=0.002), respectively. In a multivariable Cox regression analysis, we found that unlike SxS (adjusted HR 1.013, 95% CI (0.96–1.07), p=0.654), SxSII was significantly associated with all-cause mortality (HR = 1.095, 95% CI (1.06–1.11), p < 0.001). This was also true for the prediction of both secondary outcomes MACE (n=60) and MACCE (n=70) with an adjusted HR = 1.055, 95% CI (1.03–1.08), p < 0.001, and HR = 1.065, 95% CI (1.04–1.09), p < 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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Karabağ Y, Çağdaş M, Rencuzogullari I, Karakoyun S, Artaç İ, İliş D, Atalay E, Yesin M, Gürsoy MO, Halil Tanboğa I. Relationship between C-reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris. J Clin Lab Anal 2018; 32:e22457. [PMID: 29667724 PMCID: PMC6816976 DOI: 10.1002/jcla.22457] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/27/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Syntax score (SS), which is an angiographic tool used in grading the complexity of coronary artery disease (CAD), has prognostic importance in coronary artery disease (CAD) and provides important information regarding selection of revascularization strategy. C-reactive protein (CRP) and albumin are indicators of inflammation, and high levels of them are associated with high SS. We aimed to investigate whether baseline CRP to albumin ratio C-Reactive Protein/Albumin Ratio (CAR), an easily available and novel inflammatory marker, is associated with SS. METHOD A total 403 consecutive patients with stabile angina pectoris, who underwent coronary angiography for suspected CAD from January 2015 to June 2016, were classified into two groups, low SS (≤22) and intermediate-high SS (>22). RESULTS C-Reactive Protein/Albumin Ratio was significantly higher in patients with intermediate-high SS group (P < .001). In multivariate regression analysis, CAR remained an independent predictor of intermediate-high SS group together with hypertension and LDL. The predictive performance of CAR, CRP, and albumin was compared by ROC curve analysis. CAR surpassed CRP and albumin in predicting intermediate-high SS group. CAR >6.3 predicted an intermediate-high SS with sensitivity and specificity of 86.8% and 43.4%, respectively. CONCLUSION C-Reactive Protein/Albumin Ratio was more tightly associated with the complexity and severity of CAD than CRP and albumin alone and was found to be an independent predictor for intermediate-high SS group.
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Affiliation(s)
- Yavuz Karabağ
- Department of CardiologyKafkas University Medical FacultyKarsTurkey
| | - Metin Çağdaş
- Department of CardiologyKafkas University Medical FacultyKarsTurkey
| | | | | | - İnanç Artaç
- Department of CardiologyKafkas University Medical FacultyKarsTurkey
| | - Doğan İliş
- Department of CardiologyKafkas University Medical FacultyKarsTurkey
| | - Eray Atalay
- Department of Internal MedicineKafkas University Medical FacultyKarsTurkey
| | - Mahmut Yesin
- Department of CardiologyKars Harakani State HospitalKarsTurkey
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Intima-media thickness and ankle-brachial index are correlated with the extent of coronary artery disease measured by the SYNTAX score. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:52-58. [PMID: 29743904 PMCID: PMC5939545 DOI: 10.5114/aic.2018.74355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 12/02/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction The extent of peripheral artery disease (PAD) measured by the ankle-brachial index (ABI) and intima-media thickness (IMT) is correlated with the complexity of coronary artery disease (CAD) in stable angina patients. However, data regarding patients with acute coronary syndromes are still lacking. Aim To compare coronary complexity measured by the SYNTAX score in patients with and without PAD presenting with myocardial infarction (MI). Material and methods Both ABI and IMT were measured in 101 consecutive patients who underwent primary diagnostic due to MI. Patients were divided into three tertile groups depending on the SYNTAX score (0-4; 5-11; 12 and more points). Results Mean ABI in the general population was 0.9 ±0.26, mean IMT was 0.8 ±0.3 mm and mean SYNTAX score was 7.8 ±5.4 points. We found significant correlations between ABI and SYNTAX score (p = 0.01), IMT and SYNTAX score (p < 0.001), and IMT and ABI (p < 0.001). The highest mean values of IMT (p < 0.001) and lowest mean values of ABI (p = 0.015) were found in patients in the highest SYNTAX score group. When analyzing receiver operating characteristics (ROC) curves, IMT had greater specificity and sensitivity than ABI. Conclusions Both IMT and ABI are correlated with SYNTAX score (positively for IMT and negatively for ABI values). In our study, IMT was a better predictor of SYNTAX score than ABI. Our study suggests that the higher rate of cardiovascular events in patients with PAD presenting with MI may be partially explained by greater coronary lesion complexity.
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Fonseca FAH, Izar MC, Maugeri IML, Berwanger O, Damiani LP, Pinto IM, Szarf G, França CN, Bianco HT, Moreira FT, Caixeta A, Alves CMR, Soriano Lopes A, Klassen A, Tavares MFM, Fonseca HA, Carvalho ACC. Effects of four antiplatelet/statin combined strategies on immune and inflammatory responses in patients with acute myocardial infarction undergoing pharmacoinvasive strategy: Design and rationale of the B and T Types of Lymphocytes Evaluation in Acute Myocardial Infarction (BATTLE-AMI) study: study protocol for a randomized controlled trial. Trials 2017; 18:601. [PMID: 29258572 PMCID: PMC5735810 DOI: 10.1186/s13063-017-2361-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/17/2017] [Indexed: 02/07/2023] Open
Abstract
Background Early reperfusion of the occluded coronary artery during acute myocardial infarction is considered crucial for reduction of infarcted mass and recovery of ventricular function. Effective microcirculation and the balance between protective and harmful lymphocytes may have roles in reperfusion injury and may affect final ventricular remodeling. Methods/design BATTLE-AMI is an open-label, randomized trial comparing the effects of four therapeutic strategies (rosuvastatin/ticagrelor, rosuvastatin/clopidogrel, simvastatin plus ezetimibe/ticagrelor, or simvastatin plus ezetimibe/clopidogrel) on infarcted mass and left ventricular ejection fraction (LVEF) (blinded endpoints) in patients with ST-segment elevation myocardial infarction submitted to fibrinolytic therapy before coronary angiogram (pharmacoinvasive strategy). All patients (n = 300, 75 per arm) will be followed up for six months. The effects of treatment on subsets of B and T lymphocytes will be determined by flow-cytometry/ELISPOT and will be correlated with the infarcted mass, LVEF, and microcirculation perfusion obtained by cardiac magnetic resonance imaging. The primary hypothesis is that the combined rosuvastatin/ticagrelor therapy will be superior to other therapies (particularly for the comparison with simvastatin plus ezetimibe/clopidogrel) for the achievement of better LVEF at 30 days (primary endpoint) and smaller infarcted mass (secondary endpoint) at 30 days and six months. The trial will also evaluate the improvement in the immune/inflammatory responses mediated by B and T lymphocytes. Omics field (metabolomics and proteomics) will help to understand these responses by molecular events. Discussion BATTLE-AMI is aimed to (1) evaluate the role of subsets of lymphocytes on microcirculation improvement and (2) show how the choice of statin/antiplatelet therapy may affect cardiac remodeling after acute myocardial infarction with ST elevation. Trial registration ClinicalTrials.gov, NCT02428374. Registered on 28 September 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2361-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francisco A H Fonseca
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil.
| | - Maria Cristina Izar
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Ieda M L Maugeri
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Otavio Berwanger
- Hospital do Coração, Rua Desembargador Eliseu Guilherme, 147, São Paulo, Brazil
| | - Lucas P Damiani
- Hospital do Coração, Rua Desembargador Eliseu Guilherme, 147, São Paulo, Brazil
| | - Ibraim M Pinto
- Instituto Dante Pazzanese de Cardiologia, Avenida Dante Pazzanese 500, São Paulo, Brazil
| | - Gilberto Szarf
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Carolina N França
- Universidade Santo Amaro, Rua Professor Enéas de Siqueira 340, São Paulo, Brazil
| | - Henrique T Bianco
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Flavio T Moreira
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Adriano Caixeta
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Claudia M R Alves
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Aline Soriano Lopes
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Aline Klassen
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Marina F M Tavares
- Universidade de São Paulo, Avenida Professor Lineu Prestes, 748, São Paulo, Brazil
| | - Henrique A Fonseca
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Antonio C C Carvalho
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
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Urso S, Tena MÁ, Mahillo-Fernández I, Ríos L, Bellot R, Sadaba R, Hernández JM, Abad C, Portela F. Análisis de predictores independientes del flujo del bypass coronario en pacientes intervenidos de revascularización miocárdica aislada. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Bryniarski KL, Walters DL, Kim CJ, Soeda T, Higuma T, Yamamoto E, Xing L, Sugiyama T, Zanchin T, Bryniarski L, Dudek D, Lee H, Jang IK. SYNTAX Score and Pre- and Poststent Optical Coherence Tomography Findings in the Left Anterior Descending Coronary Artery in Patients With Stable Angina Pectoris. Am J Cardiol 2017; 120:898-903. [PMID: 28750824 DOI: 10.1016/j.amjcard.2017.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/23/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Abstract
SYNTAX score (SS) has been reported to be an independent predictor of future cardiac events including target lesion revascularization. The aim of this study was to assess the relation between SS and plaque characteristics and poststent vascular response using optical coherence tomography in coronary artery tree and left anterior descending artery (LAD) in patients with stable angina. A total of 179 lesions among 165 patients, including 100 lesions in LAD, were analyzed. Patients were stratified into tertiles. In pre-percutaneous coronary intervention analysis of whole coronary tree and LAD, lesions of the third tertile had the highest prevalence of lipid-rich plaque. Compared with the first tertile, the third tertile had greater lipid index, thinner fibrous cap, and higher prevalence of thin-cap fibroatheroma. In poststent optical coherence tomography, the incidence of stent edge dissection and irregular protrusion was higher in the third tertile compared with the first tertile in coronary tree analysis. In LAD analysis, the prevalence of irregular protrusion was the highest in the third tertile. In conclusion, high SS may reflect higher plaque vulnerability. Stent edge dissection and irregular protrusion were more frequent in patients with higher SS, indicating poor vascular response to stenting. Our results may explain higher cardiac event rate and target lesion revascularization in patients with higher SS.
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Song Y, Gao Z, Tang X, Ma Y, Jiang P, Xu J, Yao Y, Zhao X, Qiao S, Yang Y, Gao R, Xu B, Yuan J. Usefulness of the SYNTAX score II to validate 2-year outcomes in patients with complex coronary artery disease undergoing percutaneous coronary intervention: A large single-center study. Catheter Cardiovasc Interv 2017; 92:40-47. [PMID: 28895284 DOI: 10.1002/ccd.27321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 07/27/2017] [Accepted: 08/07/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Ying Song
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Zhan Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Xiaofang Tang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Yuanliang Ma
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Ping Jiang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Jingjing Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Yi Yao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Xueyan Zhao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Shubin Qiao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Yuejin Yang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Runlin Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Bo Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Jinqing Yuan
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
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Acute coronary syndromes in the very elderly: Short term prognostic performance of the SYNTAX score. Int J Cardiol 2017; 243:497-501. [DOI: 10.1016/j.ijcard.2017.05.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/10/2017] [Indexed: 12/22/2022]
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22
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He C, Song Y, Wang CS, Yao Y, Tang XF, Zhao XY, Gao RL, Yang YJ, Xu B, Yuan JQ. Prognostic Value of the Clinical SYNTAX Score on 2-Year Outcomes in Patients With Acute Coronary Syndrome Who Underwent Percutaneous Coronary Intervention. Am J Cardiol 2017; 119:1493-1499. [PMID: 28341359 DOI: 10.1016/j.amjcard.2017.02.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/19/2022]
Abstract
This prospective, single-center, observational study evaluated prognostic value of clinical SYNTAX score (CSS) on 2-year outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). The SYNTAX score (SS) is a scoring system based on the complexity and severity of coronary lesions and is thought to be a prognostic tool to predict long-term outcomes. However, SS was a sole angiographic grading tool only with no consideration for clinical factors. There are few studies investigating the prognostic value of CSS in patients with ACS who underwent PCI. From January 2013 to December 2013, 6,099 consecutive patients with ACS admitted to FuWai hospital and underwent PCI were enrolled in this study. Based on CSS, patients were divided into low CSS group (CSS ≤ 6.5; 2,012 patients), mid-CSS group (6.5 < CSS < 13.8; 2,056 patients), and high CSS group (CSS ≥ 13.8; 2,031 patients). At 2-year follow-up, rates of cardiac death and major adverse cardiac events (MACE) were significantly higher in the high CSS group. Compared with baseline SS, CSS demonstrated significantly improved performance for 2-year cardiac death (receiver-operating characteristic curve C-statistic: 0.74 vs 0.62, p <0.001) but not for MACE (receiver-operating characteristic curve C-statistic: 0.60 vs 0.59, p = 0.29). By multivariable analysis, the CSS combined with PCI history and hypertension were strong predictors for cardiac death and CSS, intra-aortic balloon pump support, diabetes, and successful PCI were independent predictors for MACE. In conclusion, compared with the anatomic SS, CSS was suitable in risk stratifying and predicting 2-year clinical outcome among ACS population.
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Affiliation(s)
- Chen He
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuang-Shi Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Yao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Fang Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Yan Zhao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Run-Lin Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Jin Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jin-Qing Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Effect of Serum Growth Differentiation Factor-15 and the Syntax Score on 2-Year Outcomes in Patients With Acute Coronary Syndrome. Am J Cardiol 2016; 117:1569-1574. [PMID: 27013387 DOI: 10.1016/j.amjcard.2016.02.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 11/21/2022]
Abstract
Growth differentiation factor-15 (GDF-15) is produced by cardiomyocytes and atherosclerotic lesions under stress conditions, but little is known about its relation with severity and complexity of coronary lesions. The aim of this study was to investigate the association between GDF-15 and the syntax score for risk prediction of major adverse cardiovascular events (MACE) at 2-year follow-up in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). This is a prospective cohort study of 502 patients with NSTEACS. The syntax score was calculated from baseline coronary angiography. Blood samples were obtained at study entry for the assessment of GDF-15 and high-sensitivity C reactive protein. One hundred and three patients (20.5%) showed MACE at 2-year follow-up. Patients who developed MACE had greater GDF-15 concentrations and syntax score (p <0.001) compared to patients who did not. There was a positive, but moderate, correlation between GDF-15 and syntax score (ρ = 0.45, p <0.0001). On Cox regression analysis, only GDF-15 levels (p <0.001), body mass index (p = 0.04), and syntax score (p <0.001) remained independent predictors of the MACE. The area under the curve of GDF-15 (0.912, 95% confidence interval 0.894 to 0.944) was significantly greater compared to high-sensitivity C reactive protein and syntax score. In conclusion, in patients with NSTEACS, levels of GDF-15 at admission were correlated with the syntax score and independently associated with an increased risk of MACE during 2-year follow-up.
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Abstract
The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a semiquantitative angiographic score developed to prospectively characterize the disease complexity of the coronary vasculature. With more than 50 validation studies, the SYNTAX score is the most-studied risk model in the setting of percutaneous coronary intervention. In this article, the evolutionary journey of the SYNTAX score is reviewed, with emphasis on its sequential modifications and adaptations, now culminating in the development and validation of the SYNTAX score II.
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Affiliation(s)
- Davide Capodanno
- Dipartimento Cardio-Toraco-Vasculare, Ferrarotto Hospital, University of Catania, Via Citelli, 6, Catania 95124, Italy.
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Salvatore A, Boukhris M, Giubilato S, Tomasello SD, Castaing M, Giunta R, Marzà F, Abdelbasset HM, Khamis H, Galassi AR. Usefulness of SYNTAX score II in complex percutaneous coronary interventions in the setting of acute coronary syndrome. J Saudi Heart Assoc 2016; 28:63-72. [PMID: 27053895 PMCID: PMC4803775 DOI: 10.1016/j.jsha.2015.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/10/2015] [Accepted: 07/21/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND SYNTAX score II (SS II) integrates anatomical SS with clinical characteristics allowing an individualized prediction of long-term mortality. AIMS We sought to assess to evaluate the usefulness of SS II in a real-world acute coronary syndromes (ACS) population with severe coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). METHODS From August 2011 to May 2013, out of 1591 consecutive patients admitted for ACS, 217 (13.6%) showed severe CAD (three-vessel disease and/or left main involvement). Among the latter, 100 patients underwent PCI and were enrolled into the study. SS II was calculated in all patients. One-year clinical follow-up was performed; major adverse cardiac and cerebrovascular events (MACCE) were defined as a composite of death, nonfatal myocardial infarction, stroke, or repeat revascularization. RESULTS The median SS II was 29 (range, 14-59). Overall, MACCE occurred in 25% of patients (cardiac death 4%, myocardial infarction 4%, stroke 0%, and repeat revascularization 17%). The 1-year MACCE-free survival was significantly lower in patients with SS (⩾29), than in those with SS II (<29) (64.2% vs. 87.2%, respectively; p = 0.007). In multivariate Cox regression analysis, the presence of unprotected left main stenosis [hazard ratio 2.52, 95% confidence interval (CI): 1.02-5.85; p = 0.031] and SS II ⩾29 (hazard ratio 2.74, 95% CI: 1.30-8.21; p = 0.011) were the only predictors of MACCE at 1-year clinical follow-up. The c-index of SS score II was 0.70 (95% CI: 0.58-0.81). For patients who experienced MACCE, the SS II reclassification improved by 36%, while in nonevent patients the reclassification improved by 22%. The net reclassification index was 0.24 (p = 0.09). CONCLUSION SS II might represent a useful tool to predict clinical events in not only ideal stable patients, but also an unrestricted, real world population of patients with ACS and severe CAD undergoing PCI.
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Affiliation(s)
- Azzarelli Salvatore
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
| | - Marouane Boukhris
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
- Faculty of Medicine of Tunis,University of Tunis El Manar, Tunisia
| | - Simona Giubilato
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
| | - Salvatore Davide Tomasello
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
| | - Marine Castaing
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
| | - Rocco Giunta
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
| | - Francesco Marzà
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
| | - Hosam Mohamad Abdelbasset
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
- Maadi Military Hospital, Military Medical Academy, Cairo, Egypt
| | | | - Alfredo Ruggero Galassi
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
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Akboga MK, Balci KG, Maden O, Ertem AG, Kirbas O, Yayla C, Acar B, Aras D, Kisacik H, Aydogdu S. Usefulness of monocyte to HDL-cholesterol ratio to predict high SYNTAX score in patients with stable coronary artery disease. Biomark Med 2016; 10:375-83. [PMID: 26999570 DOI: 10.2217/bmm-2015-0050] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We aimed to investigate whether baseline monocyte to high-density lipoprotein cholesterol ratio (MHR), an easily available inflammatory and oxidative stress marker, is associated with SYNTAX score. PATIENTS & METHODS In this cross-sectional study, n = 1229 consecutive patients with coronary artery disease were classified into two groups, low SYNTAX score (≤22) and high SYNTAX score (≥23). RESULTS MHRs were significantly higher in patients with high SYNTAX score (p < 0.05). In multivariate regression analysis, MHR remained as independent predictor of high SYNTAX score together with C-reactive protein (CRP), hypertension and diabetes mellitus. In correlation analysis, MHR showed significant positive correlations with SYNTAX score (r = 0.371, p < 0.001) and CRP level (r = 0.336, p < 0.001). CONCLUSION This study suggests MHR is independently associated with burden of coronary atherosclerosis.
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Affiliation(s)
- Mehmet Kadri Akboga
- Turkiye Yuksek Ihtisas Training & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Kevser Gulcihan Balci
- Turkiye Yuksek Ihtisas Training & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Orhan Maden
- Turkiye Yuksek Ihtisas Training & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Ahmet Goktug Ertem
- Turkiye Yuksek Ihtisas Training & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Ozgur Kirbas
- Turkiye Yuksek Ihtisas Training & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Cagri Yayla
- Turkiye Yuksek Ihtisas Training & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Burak Acar
- Turkiye Yuksek Ihtisas Training & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Dursun Aras
- Turkiye Yuksek Ihtisas Training & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Halil Kisacik
- Turkiye Yuksek Ihtisas Training & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Sinan Aydogdu
- Turkiye Yuksek Ihtisas Training & Research Hospital, Department of Cardiology, Ankara, Turkey
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27
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Kundi H, Kiziltunc E, Cetin M, Cicekcioglu H, Cetin ZG, Cicek G, Ornek E. Association of monocyte/HDL-C ratio with SYNTAX scores in patients with stable coronary artery disease. Herz 2016; 41:523-9. [DOI: 10.1007/s00059-015-4393-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 09/28/2015] [Accepted: 11/20/2015] [Indexed: 11/30/2022]
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Kurtul A, Murat SN, Yarlioglues M, Duran M, Ocek AH, Koseoglu C, Celık IE, Kilic A, Aksoy O. Usefulness of Serum Albumin Concentration to Predict High Coronary SYNTAX Score and In-Hospital Mortality in Patients With Acute Coronary Syndrome. Angiology 2015; 67:34-40. [PMID: 25783433 DOI: 10.1177/0003319715575220] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
High SYNTAX score is a predictor of adverse cardiovascular events, including mortality, in acute coronary syndromes (ACSs). Decreased serum albumin (SA) concentration is associated with an increased risk of cardiovascular events. We aimed to investigate whether SA levels at admission are associated with high SYNTAX score and in-hospital mortality in patients with ACS. The study included 1303 patients with ACS who underwent coronary angiography (CA). The patients were divided into 2 groups as high SYNTAX score (≥33) and lower SYNTAX score (≤32). Baseline SA levels were significantly lower in patients with high SYNTAX score than with lower SYNTAX score (3.46 ± 0.42 mg/dL vs 3.97±0.37 mg/dL, respectively; P < .001). On multivariate logistic regression, SA (<3.65 mg/dL) was an independent predictor of high SYNTAX score (odds ratio 4.329, 95% confidence interval 2.028-8.264; P < .001) together with admission glucose, estimated glomerular filtration rate, and left ventricular ejection fraction. In Cox regression analyses, systolic blood pressure, high SYNTAX score, and SA (<3.65 mg/dL) were found as independent predictors of in-hospital all-cause mortality. In conclusion, SA concentration on admission is inversely associated with high SYNTAX score and in-hospital mortality in ACS.
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Affiliation(s)
- Alparslan Kurtul
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Sani Namik Murat
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mikail Yarlioglues
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mustafa Duran
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Adil Hakan Ocek
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Cemal Koseoglu
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Ibrahim Etem Celık
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Alparslan Kilic
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Ozlem Aksoy
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
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29
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Kundi H, Erel Ö, Balun A, Çiçekçioğlu H, Cetin M, Kiziltunç E, Neşelioğlu S, Topçuoğlu C, Örnek E. Association of thiol/disulfide ratio with syntax score in patients with NSTEMI. SCAND CARDIOVASC J 2015; 49:95-100. [PMID: 25658436 DOI: 10.3109/14017431.2015.1013153] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Harun Kundi
- Department of Cardiology, Ankara Numune Education and Research Hospital , Ankara , Turkey
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30
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Wang X, Dang A, Lv N, Liu Q, Chen B. High-sensitivity C-reactive protein predicts adverse cardiovascular events in patients with Takayasu arteritis with coronary artery involvement. Clin Rheumatol 2015; 35:679-84. [PMID: 25665822 DOI: 10.1007/s10067-015-2873-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/11/2015] [Accepted: 01/13/2015] [Indexed: 11/27/2022]
Abstract
The study aimed to assess the association of high-sensitivity C-reactive protein (hsCRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) to major adverse cardiovascular events (MACE) in Takayasu arteritis (TA) patients with coronary artery disease (CAD). Data on 60 TA patients with CAD and 60 age- and severity-matched patients with CAD hospitalized in Fuwai Hospital from 2005 to August 2014 were assessed. The clinical features, laboratory data, coronary angiographic findings, treatment, and follow-up outcomes were summarized retrospectively. MACE were defined as death from cardiac causes, myocardial infarction, nonfatal target vessel revascularization, or rehospitalization due to unstable or progressive angina. CAD patients had more atherogenic lipid and lipoprotein profiles such as lower levels of high-density lipoprotein cholesterol (HDL-C) (1.0 ± 0.2 vs. 1.3 ± 0.3 mmol/L, p = 0.01) and higher levels of low-density lipoprotein cholesterol (LDL-C) (2.5 ± 0.9 vs. 2.2 ± 1.1 mmol/L, p = 0.04) in contrast with TA-CAD patients. During a mean follow-up period of 3.2 years, 31 patients with Takayasu coronary arteritis reached the endpoint. Multivariate Cox proportional hazards model demonstrated that log(hsCRP) (HR = 5.3, 95 % CI = 1.1-27.8, p = 0.04) was a significant and independent predictor of MACE in patients with Takayasu coronary arteritis. Elevated baseline levels of hsCRP predict cardiovascular events, independent of other prognostic markers in TA-related CAD patients.
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Affiliation(s)
- X Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - A Dang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.
| | - N Lv
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Q Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - B Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
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Liou K, Jepson N, Kellar P, Ng B, Isbister J, Giles R, Friedman D, Allan R, Lau A, Pitney M, Ooi SY. Prognostic Significance of Peri-procedural Myocardial Infarction in the Era of High Sensitivity Troponin: A Validation of the Joint ACCF/AHA/ESC/WHF Universal Definition of Type 4a Myocardial Infarction with High Sensitivity Troponin T. Heart Lung Circ 2015; 24:673-81. [PMID: 25697382 DOI: 10.1016/j.hlc.2015.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/01/2015] [Accepted: 01/05/2015] [Indexed: 11/18/2022]
Abstract
AIMS This study aims to validate the joint ACCF/AHA/ESC/WHF Universal Definition of peri-procedural myocardial infarction (PMI) with high sensitivity troponin T (hsTnT). METHODS A retrospective cohort study encompassing patients admitted to our institution between May 2012 and April 2013 was performed. RESULTS 630 patients underwent percutaneous coronary interventions during the study period. Among them, 459 patients met the inclusion criteria and were eligible for analyses. 76.9% of these patients were male, while the mean age was 68.6. PMI was observed in 4.3% of the patients based on the Universal Definition. The predictors of PMI were chronic kidney disease (OR: 3.0, p=0.026), family history of cardiovascular disease (OR: 2.7, p=0.043) and use of IIb/IIIa inhibitors (OR 4.2, p=0.01). MACE was reported in 4.4% of the patients at 12 months, and was significantly and independently associated with PMI (OR 7.3, p=0.003) in a multivariate model which accounted for lesion complexity, patients' baseline clinical information, dual-antiplatelet status at follow-up and various procedural characteristics. The post-procedural hsTnT was much higher in those who suffered MACE than those who did not (156 v.s. 43 ng/L, p<0.001). CONCLUSION PMI as defined by the current Universal Definition using hsTnT is an independent predictor of adverse clinical outcome at 12 months in patients undergoing PCI. Accordingly, PMI remains a clinically relevant factor in current practice and should be considered a key outcome measure in clinical trials and a potential target for therapy.
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Affiliation(s)
- Kevin Liou
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia.
| | - Nigel Jepson
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Petrina Kellar
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Ben Ng
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Julia Isbister
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Robert Giles
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Daniel Friedman
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Roger Allan
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia
| | - Antony Lau
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia
| | - Mark Pitney
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Sze-Yuan Ooi
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia
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Kurtul A, Murat SN, Yarlioglues M, Duran M, Ergun G, Acikgoz SK, Demircelik MB, Cetin M, Akyel A, Kasapkara HA, Ornek E. Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes. Am J Cardiol 2014; 114:972-8. [PMID: 25118117 DOI: 10.1016/j.amjcard.2014.07.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 11/19/2022]
Abstract
The SYNTAX score (SXscore) is an anatomic scoring system based on coronary angiography (CA) that not only quantifies lesion severity and complexity but also predicts poor cardiovascular outcomes, including mortality, in patients with acute coronary syndromes (ACS). Recent studies have shown that platelet-to-lymphocyte ratio (PLR) is associated with worse outcomes in many cardiovascular diseases. The aim of this study was to investigate the association of PLR with the severity and complexity of coronary atherosclerosis as assessed by the SXscore in patients with ACS who underwent urgent CA. A total of 1,016 patients with ACS who underwent urgent CA were included in the study from August 2012 to March 2014. Admission PLR values were calculated before CA was performed. The SXscore was determined from baseline CA. The patients were divided into 2 groups, those with low SXscores (≤22) and those with intermediate to high SXscores (≥23). PLRs were significantly higher in patients with intermediate to high SXscores compared with those with low SXscores (p<0.001). In-hospital mortality was significantly higher in the groups with high PLR and intermediate to high SXscores. In multivariate analysis, the independent predictors of intermediate to high SXscore were PLR (odds ratio 1.018, 95% confidence interval 1.013 to 1.023, p<0.001) together with the left ventricular ejection fraction (odds ratio 0.935, 95% confidence interval 0.910 to 0.960, p<0.001), and age (odds ratio 1.029, 95% confidence interval 1.029 to 1.054, p=0.02). A PLR≥116 had 71% sensitivity and 66% specificity in predicting intermediate to high SXscore. In conclusion, the PLR at admission is significantly associated with the severity and complexity of coronary atherosclerosis in patients with ACS. Increased PLR is an independent predictor of higher SXscore in patients with ACS who undergo urgent CA.
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Affiliation(s)
- Alparslan Kurtul
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.
| | - Sani Namik Murat
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mikail Yarlioglues
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mustafa Duran
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Gokhan Ergun
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Sadik Kadri Acikgoz
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | | | - Mustafa Cetin
- Department of Cardiology, Numune Education and Research Hospital, Ankara, Turkey
| | - Ahmet Akyel
- Department of Cardiology, Diskapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Haci Ahmet Kasapkara
- Department of Cardiology, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Ender Ornek
- Department of Cardiology, Numune Education and Research Hospital, Ankara, Turkey
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Ugur M, Uluganyan M, Cicek G, Bozbay M, Ekmekci A, Koroglu B, Karaca G, Murat A, Tusun E, Kalaycioglu E, Uyarel H, Eren M. The Reliability of Computed Tomography-Derived SYNTAX Score Measurement. Angiology 2014; 66:150-4. [DOI: 10.1177/0003319714520953] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (SS) was developed for evaluation of coronary artery disease complexity. We aimed to compare the SS calculated by conventional coronary angiography (CAG) and computed tomography angiography (CTA). Retrospectively, 107 patients were recruited (mean age 55.9 ± 12.4 years). The SS measured by conventional CAG was divided into 3 groups (group 1 SS ≤ 22, group 2 SS > 22 to <32, and group 3 SS ≥ 32). The SS calculated by both methods has a high correlation ( r = .972 and P < .001). The κ analysis showed a substantial agreement between both imaging modalities. Computed tomography angiography highly predicted conventional CAG lesions (area under curve 0.96, 95% confidence interval 0.92-0.99, and P < .001). The SS measured by CTA is highly correlated with conventional CAG. Therefore, we propose that prior to coronary revascularization, CTA-derived SS could be used for risk stratification.
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Affiliation(s)
- Murat Ugur
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | | | - Gokhan Cicek
- Clinic of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mehmet Bozbay
- Clinic of Cardiology, Marmara University Hospital, Istanbul, Turkey
| | - Ahmet Ekmekci
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Bayram Koroglu
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Gurkan Karaca
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Murat
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Eyyup Tusun
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Ezgi Kalaycioglu
- Clinic of Cardiology, Ahi Evren Cardiovascular Surgery Center Training and Research Hospital, Kirsehir, Turkey
| | - Hüseyin Uyarel
- Clinic of Cardiology, Bezmialen University Hospital, Istanbul, Turkey
| | - Mehmet Eren
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
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