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Zhang X, Wang X, Xu L, Liu J, Ren P, Wu H. The predictive value of machine learning for mortality risk in patients with acute coronary syndromes: a systematic review and meta-analysis. Eur J Med Res 2023; 28:451. [PMID: 37864271 PMCID: PMC10588162 DOI: 10.1186/s40001-023-01027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Acute coronary syndromes (ACS) are the leading cause of global death. Optimizing mortality risk prediction and early identification of high-risk patients is essential for developing targeted prevention strategies. Many researchers have built machine learning (ML) models to predict the mortality risk in ACS patients. Our meta-analysis aimed to evaluate the predictive value of various ML models in predicting death in ACS patients at different times. METHODS PubMed, Embase, Web of Science, and Cochrane Library were searched systematically from database establishment to March 12, 2022 for studies developing or validating at least one ML predictive model for death in ACS patients. We used PROBAST to assess the risk of bias in the reported predictive models and a random-effects model to assess the pooled C-index and accuracy of these models. RESULTS Fifty papers were included, involving 216 ML prediction models, 119 of which were externally validated. The combined C-index of the ML models in the validation cohort predicting the in-hospital mortality, 30-day mortality, 3- or 6-month mortality, and 1 year or above mortality in ACS patients were 0.8633 (95% CI 0.8467-0.8802), 0.8296 (95% CI 0.8134-0.8462), 0.8205 (95% CI 0.7881-0.8541), and 0.8197 (95% CI 0.8042-0.8354), respectively, with the corresponding combined accuracy of 0.8569 (95% CI 0.8411-0.8715), 0.8282 (95% CI 0.7922-0.8591), 0.7303 (95% CI 0.7184-0.7418), and 0.7837 (95% CI 0.7455-0.8175), indicating that the ML models were relatively excellent in predicting ACS mortality at different times. Furthermore, common predictors of death in ML models included age, sex, systolic blood pressure, serum creatinine, Killip class, heart rate, diastolic blood pressure, blood glucose, and hemoglobin. CONCLUSIONS The ML models had excellent predictive power for mortality in ACS, and the methodologies may need to be addressed before they can be used in clinical practice.
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Affiliation(s)
- Xiaoxiao Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xi Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Luxin Xu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jia Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Peng Ren
- School of Life Science and Engineering, Southwest University of Science and Technology, Mianyang, China
| | - Huanlin Wu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
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2
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van Bergeijk KH, Wykrzykowska JJ, van Mieghem NM, Windecker S, Sondergaard L, Gada H, Li S, Hanson T, Deeb GM, Voors AA, Reardon MJ. Predicting 5-Year Clinical Outcomes After Transcatheter or Surgical Aortic Valve Replacement (a Risk Score from the SURTAVI Trial). Am J Cardiol 2023; 200:78-86. [PMID: 37307783 DOI: 10.1016/j.amjcard.2023.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/05/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023]
Abstract
Risk prediction scores for long-term outcomes after transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) are lacking. This study aimed to develop preprocedural risk scores for 5-year clinical outcomes after TAVI or SAVR. This analysis included 1,660 patients at an intermediate surgical risk with severe aortic stenosis randomly assigned to TAVI (n = 864) or SAVR (n = 796) from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. The primary end point was a composite of all-cause mortality or disabling stroke at 5 years. The secondary end point was a composite of cardiovascular mortality or hospitalizations for valve disease or worsening heart failure at 5 years. Preprocedural multivariable predictors of clinical outcomes were used to calculate a simple risk score for both procedures. At 5 years, the primary end point occurred in 31.3% of the patients with TAVI and 30.8% of the patients with SAVR. Preprocedural predictors differed between TAVI and SAVR. Baseline anticoagulant use was a common predictor for events in both procedures, whereas male sex and a left ventricular ejection fraction <60% were significant predictors for events in patients with TAVI and SAVR, respectively. A total of 4 simple scoring systems were created based on these multivariable predictors. The C-statistics of all models were modest but performed better than the contemporary risk scores. In conclusion, preprocedural predictors of events differ between TAVI and SAVR, necessitating separate risk models. Despite the modest predictive value of the SURTAVI risk scores, they appeared superior to other contemporary scores. Further research is needed to strengthen and validate our risk scores, possibly by including biomarker and echocardiographic parameters.
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Affiliation(s)
- Kees H van Bergeijk
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joanna J Wykrzykowska
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | | | | | | - Hemal Gada
- University of Pittsburgh Medical Center Pinnacle Health, Pittsburgh, Pennsylvania
| | - Shuzhen Li
- Statistical Services, Medtronic, Minneapolis, Minnesota
| | - Tim Hanson
- Statistical Services, Medtronic, Minneapolis, Minnesota
| | | | - Adriaan A Voors
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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3
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Relationship between the triglyceride-glucose index and the SYNTAX score 2 in patients with non-ST elevation myocardial infarction. Cardiovasc Endocrinol Metab 2023; 12:e0277. [PMID: 36699193 PMCID: PMC9829247 DOI: 10.1097/xce.0000000000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/12/2022] [Indexed: 01/10/2023]
Abstract
We evaluated if admissiontriglyceride-glucose index (TyG index) correlated with the anatomical synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score 2 in non-ST elevation myocardial infarction (NSTEMI), nondiabetic patients. Methods SYNTAX score 2 (SSII) was retrospectively evaluated in 260 nondiabetic patients hospitalized with NSTEMI who underwent coronary angiography. The TyG index was calculated using the following equation: log [fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2]. We stratified patients according to tertiles of SSII (≤21.5, 21.5-30.6, and ≥30.6). These score ranges were defined as SSII low, SSII mid, and SSII high, respectively. Results The average age of the patients was 57.2 ± 10.9 years; 135 patients (52.2%) were males. The average TyG index was 8.68 ± 0.12, and SSII was 18.9 ± 9.9. A moderate correlation was found between TyG index and SSII (r = 0.347; P < 0.001) and TyG index was independent risk factors for SSII high [odds ratio (OR), 6.0; 95% CI, 2.7-17.0; P < 0.001]. Conclusion In nondiabetic patients with NSTEMI, TyG index correlated with the SSII.
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4
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Askin L. The Clinical Value of Syntax Scores in Predicting Coronary Artery Disease Outcomes. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2022. [DOI: 10.15212/cvia.2022.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (SS) hassignificantly improved angiographic risk stratification. By analyzing angiographic variables, this score characterizescoronary artery disease qualitatively and quantitatively. To date, combining this score with other non-angiographic clinicalscores has broadened perspectives regarding risk estimation, and future research on this topic appears promising.
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Wang XF, Zhao M, Liu F, Sun GR. Value of GRACE and SYNTAX scores for predicting the prognosis of patients with non-ST elevation acute coronary syndrome. World J Clin Cases 2021; 9:10143-10150. [PMID: 34904084 PMCID: PMC8638065 DOI: 10.12998/wjcc.v9.i33.10143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND GRACE and SYNTAX scores are important tools to assess prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, there have been few studies on their value in patients receiving different types of therapies.
AIM To explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies.
METHODS The data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups. A total of 195 patients who received agents alone comprised the medication group, 156 who received medical therapy combined with stents comprised the stent group, and 35 patients who were given agents and underwent coronary artery bypass grafting (CABG) comprised the CABG group. General information was compared among the three groups. GRACE and SYNTAX scores were calculated. The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events (MACEs) was analyzed. Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS. Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model.
RESULTS The incidence of MACE increased with the elevation of GRACE and SYNTAX scores (all P < 0.05). The incidence of MACE was 18.5%, 36.5%, and 42.9% in the medication group, stent group, and CABG group, respectively. By comparison, the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups (all P < 0.05). The incidence of MACE was 6.2%, 28.0% and 40.0% in patients with a low GRACE score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 31.0%, 30.3% and 42.9% in patients with a medium GRACE score in the medication group, stent group, and CABG group, respectively (P > 0.05). The incidence of MACE was 16.9%, 46.2%, and 43.8% in patients with a high GRACE score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 16.2%, 35.4% and 60.0% in patients with a low SYNTAX score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 37.5%, 40.9%, and 41.7% in patients with a medium SYNTAX score in the medication group, stent group, and CABG group, respectively (P > 0.05). MACE incidence was 50.0%, 75.0%, and 25.0% in patients with a high SYNTAX score in the medication group, stent group, and CABG group, respectively (P < 0.05). Univariate Cox regression analyses showed that both GRACE score (hazard ratio [HR] = 1.212, 95% confidence interval [CI]: 1.083 to 1.176; P < 0.05) and SYNTAX score (HR = 1.160, 95%CI: 1.104 to 1.192; P < 0.05) were factors influencing MACE (all P < 0.05). Multivariate Cox regression analyses showed that GRACE (HR = 1.091, 95%CI: 1.015 to 1.037; P < 0.05) and SYNTAX scores (HR = 1.031, 95%CI: 1.076 to 1.143; P < 0.05) were independent predictors of MACE (all P < 0.05).
CONCLUSION GRACE and SYNTAX scores are of great value for evaluating the prognosis of NSTE-ACS patients, and prevention and early intervention strategies should be used in clinical practice targeting different risk scores.
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Affiliation(s)
- Xiao-Feng Wang
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Ming Zhao
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Fei Liu
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Guo-Rong Sun
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
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Kilic A, Baydar O. Relationship Between Fasting Glucose, HbA 1c Levels, and the SYNTAX Score 2 in Patients With Non-ST-Elevation Myocardial Infarction. Angiology 2021; 73:177-181. [PMID: 33960202 DOI: 10.1177/00033197211014678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We evaluated if admission glycosylated hemoglobin (HbA1c) and fasting glucose levels are correlated with the severity of coronary artery disease (CAD) in non-ST-elevation myocardial infarction (NSTEMI), nondiabetic, patients. Coronary artery disease severity, according to the anatomical synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery (SYNTAX) score 2 (SSII), was retrospectively evaluated in 359 nondiabetic patients hospitalized with NSTEMI who underwent coronary angiography. Glucose intolerance was assessed by serum fasting glucose and HbA1c levels. We stratified patients according to tertiles of SSII (≤21.5, 21.5-30.6, and ≥30.6). These score ranges were defined as SSII low, SSII mid, and SSII high, respectively. The average age of the patients was 57.1 ± 10.9 years; 189 (52.1%) patients were males. The average fasting glucose was 114 ± 52 mg/dL, HbA1c was 5.8% ± 0.9%, and SSII was 18.9 ± 10.3. A stronger correlation was found between HbA1c and SSII than fasting glucose and SSII (r1 = 0.901, P < .001, r2 = 0.378, P < .001, respectively), and HbA1c level and hypertension were independent risk factors for SSII high (odds ratio [OR]: 2.2 (95% CI: 0.5-9.0, P < .001; OR: 1.1 (1.0-1.3), P = .007, respectively). In conclusion, in nondiabetic patients with NSTEMI, HbA1c levels correlated with CAD severity as measured by the SSII.
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Affiliation(s)
- Alparslan Kilic
- Department of Cardiology, 52979Koc University Hospital, Istanbul, Turkey
| | - Onur Baydar
- Department of Cardiology, 52979Koc University Hospital, Istanbul, Turkey
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7
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Chichareon P, van Klaveren D, Modolo R, Kogame N, Takahashi K, Chang CC, Tomaniak M, Yuan J, Xie L, Song Y, Qiao S, Yang Y, Guan C, Zurakowski A, van Geuns RJ, Sabate M, Ong PJ, Wykrzykowska JJ, Piek JJ, Garg S, Hamm C, Steg G, Vranckx P, Valgimigli M, Windecker S, Juni P, Onuma Y, Steyerberg E, Xu B, Serruys PW. Predicting 2-year all-cause mortality after contemporary PCI: Updating the logistic clinical SYNTAX score. Catheter Cardiovasc Interv 2021; 98:1287-1297. [PMID: 33539048 DOI: 10.1002/ccd.29490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/02/2020] [Accepted: 12/27/2020] [Indexed: 01/04/2023]
Abstract
AIMS We aimed to update the logistic clinical SYNTAX score to predict 2 year all-cause mortality after contemporary percutaneous coronary intervention (PCI). METHODS AND RESULTS We analyzed 15,883 patients in the GLOBAL LEADERS study who underwent PCI. The logistic clinical SYNTAX model was updated after imputing missing values by refitting the original model (refitted original model) and fitting an extended new model (new model, with, selection based on the Akaike Information Criterion). External validation was performed in 10,100 patients having PCI at Fu Wai hospital. Chronic obstructive pulmonary disease, prior stroke, current smoker, hemoglobin level, and white blood cell count were identified as additional independent predictors of 2 year all-cause mortality and included into the new model. The c-indexes of the original, refitted original and the new model in the derivation cohort were 0.74 (95% CI 0.72-0.76), 0.75 (95% CI 0.73-0.77), and 0.78 (95% CI 0.76-0.80), respectively. The c-index of the new model was lower in the validation cohort than in the derivation cohort, but still showed improved discriminative ability of the newly developed model (0.72; 95% CI 0.67-0.77) compared to the refitted original model (0.69; 95% CI 0.64-0.74). The models overestimated the observed 2 year all-cause mortality of 1.11% in the Chinese external validation cohort by 0.54 percentage points, indicating the need for calibration of the model to the Chinese patient population. CONCLUSIONS The new model of the logistic clinical SYNTAX score better predicts 2 year all-cause mortality after PCI than the original model. The new model could guide clinical decision making by risk stratifying patients undergoing PCI.
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Affiliation(s)
- Ply Chichareon
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - David van Klaveren
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Rodrigo Modolo
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
| | - Norihiro Kogame
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kuniaki Takahashi
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Chun-Chin Chang
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mariusz Tomaniak
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Jinqing Yuan
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Lihua Xie
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Ying Song
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Shubin Qiao
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Yuejin Yang
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Changdong Guan
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Aleksander Zurakowski
- American Heart of Poland, Center for Cardiovascular Research and Development, Katowice, Poland
| | - Robert-Jan van Geuns
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manel Sabate
- University Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Paul J Ong
- Tan Tock Seng Hospital, Novena, Singapore
| | - Joanna J Wykrzykowska
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan J Piek
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Christian Hamm
- Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany
| | - Gabriel Steg
- FACT, French Alliance for Cardiovascular Trials; Hôpital Bichat, AP-HP, Université Paris-Diderot; and INSERM U-1148, all in Paris, Paris, France.,Royal Brompton Hospital, Imperial College, London, UK
| | - Pascal Vranckx
- Hartcentrum Hasselt, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Peter Juni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Canada
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Ewout Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bo Xu
- National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Beijing, China
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland.,NHLI, Imperial College London, London, UK
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8
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Uygur B, Demir AR, Guner A, Iyigun T, Uzun N, Celik O. Utility of logistic clinical SYNTAX score in prediction of in-hospital mortality in ST-elevation myocardial infarction patients undergoing emergent coronary artery bypass graft surgery. J Card Surg 2021; 36:857-863. [PMID: 33415773 DOI: 10.1111/jocs.15308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
AIM The logistic clinical SYNTAX score (log CSS) is a combined risk scoring system including clinical and anatomic parameters; it has been found to be effective for the prediction of mortality in patients with ST-elevation myocardial infarction (STEMI). Coronary artery bypass grafting (CABG) in the primary treatment of acute myocardial infarction is still debated. In the present study, we aimed to evaluate the utility of log CSS to stratify the risk of in-hospital mortality in acute STEMI patients undergoing emergent CABG for primary revascularization. METHOD In total, 88 consecutive patients with acute STEMI, who did not qualify for primary percutaneous coronary intervention and required emergent CABG were included in our study. Nine of 88 patients died during hospitalization. The study population was divided into two groups as in-hospital survivors and non-survivors. Log CSS and SYNTAX score (SS) were calculated for both groups and two groups were compared in terms of demographics, preoperative, intraoperative, postoperative characteristics, SS and log CSS. RESULTS Log CSS was found to be an independent predictor of in-hospital mortality, log CSS > 10.5 had 89% sensitivity, 81% specificity (area under the curve: 0.927; 95% confidence interval: 0.855-0.993). Moreover, peak troponin level was an independent predictor of in-hospital mortality. Glucose level, cardiopulmonary resuscitation before operation, glomerular filtration rate, left ventricular ejection fraction, and Killip class were significantly associated with in-hospital mortality. CONCLUSION Log CSS may improve the accuracy of risk assessment in patients who are undergoing emergent CABG for primary revascularization of STEMI.
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Affiliation(s)
- Begum Uygur
- Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Ali R Demir
- Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Ahmet Guner
- Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Taner Iyigun
- Cardiovascular Surgery Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Nedim Uzun
- Emergency Department, Gaziosmanpasa Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Omer Celik
- Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Science, Istanbul, Turkey
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9
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Qiao HY, Li JH, Schoepf UJ, Bayer RR, Tinnefeld FC, Di Jiang M, Yang F, Guo BJ, Zhou CS, Ge YQ, Lu MJ, Jiang JW, Lu GM, Zhang LJ. Prognostic implication of CT-FFR based functional SYNTAX score in patients with de novo three-vessel disease. Eur Heart J Cardiovasc Imaging 2020:jeaa256. [PMID: 33184644 DOI: 10.1093/ehjci/jeaa256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/22/2020] [Indexed: 02/01/2023] Open
Abstract
AIMS This study was aimed at investigating whether a machine learning (ML)-based coronary computed tomographic angiography (CCTA) derived fractional flow reserve (CT-FFR) SYNTAX score (SS), 'Functional SYNTAX score' (FSSCTA), would predict clinical outcome in patients with three-vessel coronary artery disease (CAD). METHODS AND RESULTS The SS based on CCTA (SSCTA) and ICA (SSICA) were retrospectively collected in 227 consecutive patients with three-vessel CAD. FSSCTA was calculated by combining the anatomical data with functional data derived from a ML-based CT-FFR assessment. The ability of each score system to predict major adverse cardiac events (MACE) was compared. The difference between revascularization strategies directed by the anatomical SS and FSSCTA was also assessed. Two hundred and twenty-seven patients were divided into two groups according to the SSCTA cut-off value of 22. After determining FSSCTA for each patient, 22.9% of patients (52/227) were reclassified to a low-risk group (FSSCTA ≤ 22). In the low- vs. intermediate-to-high (>22) FSSCTA group, MACE occurred in 3.2% (4/125) vs. 34.3% (35/102), respectively (P < 0.001). The independent predictors of MACE were FSSCTA (OR = 1.21, P = 0.001) and diabetes (OR = 2.35, P = 0.048). FSSCTA demonstrated a better predictive accuracy for MACE compared with SSCTA (AUC: 0.81 vs. 0.75, P = 0.01) and SSICA (0.81 vs. 0.75, P < 0.001). After FSSCTA was revealed, 52 patients initially referred for CABG based on SSCTA would have been changed to PCI. CONCLUSION Recalculating SS by incorporating lesion-specific ischaemia as determined by ML-based CT-FFR is a better predictor of MACE in patients with three-vessel CAD. Additionally, the use of FSSCTA may alter selected revascularization strategies in these patients.
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Affiliation(s)
- Hong Yan Qiao
- Department of Medical Imaging, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210002, China
- Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214041, China
| | - Jian Hua Li
- Department of Cardiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Fiona C Tinnefeld
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Meng Di Jiang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Fei Yang
- Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214041, China
| | - Bang Jun Guo
- Department of Medical Imaging, Jinling Hospital, Medical School of Southern Medical University, Nanjing, Jiangsu 210002, China
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210002, China
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Ying Qian Ge
- CT Scientific Marketing, Siemens Healthcare, Shanghai, China
| | - Meng Jie Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Jian Wei Jiang
- Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214041, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210002, China
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
- Department of Medical Imaging, Jinling Hospital, Medical School of Southern Medical University, Nanjing, Jiangsu 210002, China
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10
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Kawashima H, Hara H, Wang R, Ono M, Gao C, Takahashi K, Suryapranata H, Walsh S, Cotton J, Carrie D, Sabate M, Steinwender C, Leibundgut G, Wykrzykowska J, Hamm C, Jüni P, Vranckx P, Valgimigli M, Windecker S, Winter RJ, Sharif F, Onuma Y, Serruys PW. Usefulness of updated logistic clinical SYNTAX score based on MI‐SYNTAX score in patients with ST‐elevation myocardial infarction. Catheter Cardiovasc Interv 2020; 97:E919-E928. [DOI: 10.1002/ccd.29383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/07/2020] [Accepted: 10/22/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Hideyuki Kawashima
- Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam Amsterdam Netherlands
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
| | - Hironori Hara
- Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam Amsterdam Netherlands
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
| | - Rutao Wang
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
- Department of Cardiology Radboudumc Nijmegen Netherlands
| | - Masafumi Ono
- Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam Amsterdam Netherlands
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
| | - Chao Gao
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
- Department of Cardiology Radboudumc Nijmegen Netherlands
| | - Kuniaki Takahashi
- Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam Amsterdam Netherlands
| | | | - Simon Walsh
- Department of Cardiology Belfast Health and Social Care Trust Belfast UK
| | - James Cotton
- Heart and Lung Centre New Cross Hospital Wolverhampton UK
| | - Didier Carrie
- Department of Cardiology, Rangueil hospital Paul Sabatier University Toulouse 3 Toulouse France
| | | | - Clemens Steinwender
- Department of Cardiology Kepler University Hospital Linz Medical Faculty Johannes Kepler University Linz Linz Austria
| | - Gregor Leibundgut
- Department of Cardiology Kantonsspital Baselland, Standort Liestal Liestal Switzerland
| | | | - Christian Hamm
- Kerckhoff Heart Center Campus University of Giessen Bad Nauheim Germany
| | - Peter Jüni
- Université Paris‐Diderot, Hôpital Bichat Assistance Publique–Hôpitaux de Paris, INSERM U‐1148, FACT (French Alliance for Cardiovascular Trials) Paris France
| | - Pascal Vranckx
- Jessa Ziekenhuis Faculty of Medicine and Life Sciences at the Hasselt University Hasselt Belgium
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Inselspital University of Bern Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital University of Bern Bern Switzerland
| | - Robbert J. Winter
- Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam Amsterdam Netherlands
| | - Faisal Sharif
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
| | - Yoshinobu Onuma
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
| | - Patrick W. Serruys
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
- NHLI Imperial College London London UK
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11
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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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12
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Hara H, Kogame N, Takahashi K, Modolo R, Chichareon P, Tomaniak M, Ono M, Kawashima H, Gao C, Wang R, Valkov VD, vom Dahl J, Steinwender C, Geisler T, Lemos Neto PA, Macaya Miguel C, Garg S, Jüni P, Hamm C, Steg PG, Valgimigli M, Vranckx P, Windecker S, Farooq V, Onuma Y, Serruys PW. Usefulness of the updated logistic clinical
SYNTAX
score after percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Insights from the
GLOBAL LEADERS
trial. Catheter Cardiovasc Interv 2020; 96:E516-E526. [DOI: 10.1002/ccd.28898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Hironori Hara
- Department of Cardiology, Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | - Norihiro Kogame
- Department of Cardiology, Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | - Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | - Ply Chichareon
- Department of Cardiology, Academic Medical Center University of Amsterdam Amsterdam The Netherlands
- Cardiology unit, Department of Internal Medicine Faculty of Medicine, Prince of Songkla University Songkhla Thailand
| | - Mariusz Tomaniak
- Department of Cardiology, Erasmus Medical Center Erasmus University Rotterdam The Netherlands
- First Department of Cardiology Medical University of Warsaw Warsaw Poland
| | - Masafumi Ono
- Department of Cardiology, Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | - Chao Gao
- Department of Cardiology Radboud University Nijmegen The Netherlands
| | - Rutao Wang
- Department of Cardiology Radboud University Nijmegen The Netherlands
| | | | - Jürgen vom Dahl
- Klinik f. Kardiologie/Intern, Intensivmedizin, Kliniken Maria Hilf GmbH Akademisches Lehrkrankenhaus der RWTH Aachen Mönchengladbach Germany
| | - Clemens Steinwender
- Department of Cardiology Kepler University Hospital Linz, Medical Faculty, Johannes Kepler University Linz Austria
| | - Tobias Geisler
- Department of Cardiology and Angiology University Hospital Tübingen Tübingen Germany
| | - Pedro Alves Lemos Neto
- Heart Institute (InCor) University of Sao Paulo Medical School São Paulo Brazil
- Interventional Cardiology Hospital Israelita Albert Einstein São Paulo Brazil
| | - Carlos Macaya Miguel
- Department of Cardiology, Instituto Cardiovascular, Hospital Clínico San Carlos Universidad Complutense Madrid Spain
| | - Scot Garg
- Department of Cardiology Royal Blackburn Hospital Blackburn United Kingdom
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada
| | - Christian Hamm
- Kerckhoff Heart Center Campus University of Giessen Bad Nauheim Germany
| | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Clinical Trials), DHU FIRE, INSERM Unité 1148, Université de Paris, and Hôpital Bichat, Assistance‐Publique‐Hôpitaux de Paris, Paris, France, and NHLI, Imperial College Royal Brompton Hospital London United Kingdom
| | - Marco Valgimigli
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Pascal Vranckx
- Department of Cardiology and Intensive Care Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences University of Hasselt Hasselt Belgium
| | | | - Vasim Farooq
- Manchester Heart Centre, Manchester Royal Infirmary Central Manchester University Hospitals Manchester United Kingdom
| | - Yoshinobu Onuma
- Department of cardiology National University of Ireland Galway (NUIG) Galway Ireland
| | - Patrick W. Serruys
- Department of cardiology National University of Ireland Galway (NUIG) Galway Ireland
- NHLI Imperial College London London United Kingdom
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13
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Cerrato E, Barbero U, Quadri G, Ryan N, D'Ascenzo F, Tomassini F, Quirós A, Bellucca S, Conrotto F, Ugo F, Kawamoto H, Rolfo C, Pavani M, Mejia-Renteria H, Gili S, Iannaccone M, Debenedictis M, Baldassarre D, Biondi-Zoccai G, Colombo A, Varbella F, Escaned J. Prediction of long-term patient outcome after contemporary left main stenting using the SYNTAX and SYNTAX II scores: A comparative analysis from the FAIL-II multicenter registry (failure in left main study with 2nd generation stents-Cardiogroup III study). Catheter Cardiovasc Interv 2019; 96:E17-E26. [PMID: 31478334 DOI: 10.1002/ccd.28468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/24/2019] [Accepted: 08/17/2019] [Indexed: 02/05/2023]
Abstract
AIMS To establish the value of the SYNTAX Score-II (SS-II) in predicting long-term mortality of patients treated with left main PCI (LM-PCI) using second-generation drug-eluting stents (DES). METHODS AND RESULTS The SYNTAX score (SS) and the SS-II were calculated in 804 patients included in the FAILS-2 registry (failure in left main study with 2nd generation stents). Patients were classified in low (SS-II ≤33; n = 278, 34.6%), intermediate (SS-II 34-43; n = 260, 32.3%) and high (SS-II ≥44; n = 266, 33.1%) SS-II tertiles. Primary endpoint was all-cause mortality. A significant difference in long-term mortality was noted (5.2 ± 3.6 years): 4.1, 7.5, and 16.7% in low, mid and high SS-II tertiles respectively (p < .001). SS-II score was more accurate in predicting mortality than SS (AUC = 0.73; 95%CI: 0.67-0.79 vs. AUC = 0.55; 95%CI: 0.48-0.63, respectively; p < .001). SS-II led to a reclassification in the risk of all-cause mortality re-allocating 73% of patients from the CABG-only indication to PCI or equipoise PCI-or-CABG indication. Using multiple Cox regression analysis, SS-II (HR: 1.07; 95%CI: 1.05-1.09; p < .001), along with Acute coronary syndrome (ACS) (HR: 1.66; 95%CI: 1.03-2.66; p = .07) and Cardiogenic shock (CS) (HR: 2.82 (95%CI: 1.41-5.64; p = .003) were independent predictors of long-term mortality. SS-II (HR: 1.05; 95%CI: 1.04-1.06; p < .001) along with Insulin dependent Type 2 DM (HR: 1.58, 95%CI: 1.09-2.30.; p < .05), ACS (HR: 1.58, 95%CI: 1.16-2.14; p < .001) and CS (HR: 2.02 95%CI 1.16-3.53; p < .05), were independent predictors of long-term MACE. CONCLUSION The SS-II was superior to the SS in predicting outcomes associated with contemporary LM-PCI. In this real-world population, two clinical variables not included in the SS-II, ACS and T2DM, were identified as additional markers of poor outcome.
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Affiliation(s)
- Enrico Cerrato
- Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga, Orbassano, Italy
| | - Umberto Barbero
- Cardiology Department, "SS. Annunziata" Hospital, Savigliano, Italy.,Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Giorgio Quadri
- Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga, Orbassano, Italy
| | - Nicola Ryan
- Department of Cardiology, Hopital Clínico San Carlos, Madrid, Spain
| | - Fabrizio D'Ascenzo
- "Città della Scienza e della Salute", Department of Cardiology, University of Turin, Turin, Italy
| | - Francesco Tomassini
- Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga, Orbassano, Italy
| | | | - Simone Bellucca
- Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga, Orbassano, Italy
| | - Federico Conrotto
- "Città della Scienza e della Salute", Department of Cardiology, University of Turin, Turin, Italy
| | - Fabrizio Ugo
- Department of Cardiology, "S.G. Bosco Hospital", Turin, Italy
| | - Hiroyoshi Kawamoto
- Department of Cardiology, Scientific Institute S. Raffaele, Milan, Italy
| | - Cristina Rolfo
- Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga, Orbassano, Italy
| | - Marco Pavani
- Division of Cardiology, Ospedale Umberto I, Turin, Italy
| | | | | | - Mario Iannaccone
- Cardiology Department, "SS. Annunziata" Hospital, Savigliano, Italy
| | | | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Colombo
- Department of Cardiology, Scientific Institute S. Raffaele, Milan, Italy
| | - Ferdinando Varbella
- Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga, Orbassano, Italy
| | - Javier Escaned
- Department of Cardiology, Hopital Clínico San Carlos, Madrid, Spain
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14
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Chichareon P, Onuma Y, van Klaveren D, Modolo R, Kogame N, Takahashi K, Chang CC, Tomaniak M, Asano T, Katagiri Y, van Geuns RJM, Bolognese L, Tumscitz C, Vrolix M, Petrov I, Garg S, Naber CK, Sabaté M, Iqbal J, Wykrzykowska JJ, Piek JJ, Spitzer E, Jüni P, Hamm C, Steg PG, Valgimigli M, Vranckx P, Windecker S, Serruys PW. Validation of the updated logistic clinical SYNTAX score for all-cause mortality in the GLOBAL LEADERS trial. EUROINTERVENTION 2019; 15:e539-e546. [DOI: 10.4244/eij-d-19-00184] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Validating the Performance of 5 Risk Scores for Major Adverse Cardiac Events in Patients Who Achieved Complete Revascularization After Percutaneous Coronary Intervention. Can J Cardiol 2019; 35:1058-1068. [PMID: 31376907 DOI: 10.1016/j.cjca.2019.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/04/2019] [Accepted: 02/20/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Risk scores, like the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (SS), clinical SS, logistic SS (core model and extended model [LSSextended]), Age, Creatinine, and Ejection Fraction (ACEF) score, and modified ACEF score, are predictive for major adverse cardiac events (MACE; including all-cause mortality, myocardial infarction [MI], and revascularization) in patients who have undergone percutaneous coronary intervention (PCI). However, few studies have validated the performance of these scores in complete revascularization (CR) patients. We aimed to compare the performance of previous risk scores in patients who achieved CR after PCI. METHODS All patients (N = 10,724) who underwent PCI at Fuwai Hospital in 2013 were screened, and those who achieved CR after PCI were enrolled. Risk scores were calculated by experienced cardiologists blinded to the clinical outcomes. Discrimination of risk scores was assessed according to the area under the receiver operating characteristic curve (AUC). RESULTS Fifty-one percent (5375/10,724) of patients who underwent PCI achieved CR. At a mean follow-up of 2.4 years, the mortality, MI, revascularization, and MACE rates were 1.2%, 1.0%, 6.3%, and 7.7%, respectively. SS was not predictive for mortality (AUC, 0.51; 95% confidence interval [CI], 0.44-0.59). All scores involving clinical variables, especially modified ACEF score (AUC, 0.73; 95% CI, 0.66-0.79), could predict mortality. LSSextended was the most accurate for MI (AUC, 0.68; 95% CI, 0.61-0.75). SS and LSSextended were predictive for revascularization, with marginally significant AUCs (SS, 0.54; LSSextended, 0.55). No score was particularly accurate for predicting MACE, with AUCs ranging from 0.51 (ACEF score) to 0.58 (LSSextended). CONCLUSIONS In CR patients, risk scores involving clinical variables might help to predict mortality; however, no risk scores showed helpful discrimination for MACE.
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16
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Ferreira J. Risk stratification in acute coronary syndromes: When less is more. Rev Port Cardiol 2018; 37:921-922. [PMID: 30442522 DOI: 10.1016/j.repc.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jorge Ferreira
- Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal.
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17
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Ferreira J. Risk stratification in acute coronary syndromes: When less is more. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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18
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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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19
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Nikolsky E, Verheugt FW. Ischemia and Bleeding on the Horns of a Dilemma. J Am Coll Cardiol 2018; 72:137-140. [DOI: 10.1016/j.jacc.2018.04.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 04/29/2018] [Indexed: 11/25/2022]
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20
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Stamatelopoulos K, Mueller-Hennessen M, Georgiopoulos G, Sachse M, Boeddinghaus J, Sopova K, Gatsiou A, Amrhein C, Biener M, Vafaie M, Athanasouli F, Stakos D, Pateras K, Twerenbold R, Badertscher P, Nestelberger T, Dimmeler S, Katus HA, Zeiher AM, Mueller C, Giannitsis E, Stellos K. Amyloid-β (1-40) and Mortality in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome: A Cohort Study. Ann Intern Med 2018; 168:855-865. [PMID: 29799975 DOI: 10.7326/m17-1540] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Amyloid-β (1-40) (Aβ40) is implicated in mechanisms related to plaque destabilization and correlates with adverse outcomes in stable coronary artery disease. OBJECTIVE To determine the prognostic and reclassification value of baseline circulating levels of Aβ40 after adjustment for the Global Registry of Acute Coronary Events (GRACE) score, which is widely recommended for risk stratification in non-ST-segment elevation acute coronary syndrome (NSTE-ACS). DESIGN Retrospective cohort study using data from 2 independent prospective cohorts, the Heidelberg study (n = 1145) and the validation multicenter international APACE (Advantageous Predictors of Acute Coronary Syndrome Evaluation) study (n = 734). SETTING Academic hospitals in 7 European countries. PARTICIPANTS Patients with adjudicated NSTE-ACS followed for a median of 21.9 and 24.9 months in the Heidelberg and APACE studies, respectively. MEASUREMENTS All-cause mortality was the primary end point. RESULTS Amyloid-β (1-40) was associated with mortality after multivariate adjustment for age, sex, diabetes mellitus, high-sensitivity cardiac troponin T and C-reactive protein, revascularization, and ACS type (Heidelberg cohort hazard ratio [HR] for 80th vs. 20th percentiles, 1.66 [95% CI, 1.06 to 2.61; P = 0.026]; APACE cohort HR, 1.50 [CI, 1.15 to 1.96; P = 0.003]). It was also associated with mortality after adjustment for the GRACE score (Heidelberg cohort HR for 80th vs. 20th percentiles, 1.11 [CI, 1.04 to 1.18; P = 0.001]; APACE cohort HR, 1.39 [CI, 1.02 to 1.88; P = 0.036]). Amyloid-β (1-40) correctly reclassified risk for death over the GRACE score (net reclassification index, 33.4% and 47.1% for the Heidelberg and APACE cohorts, respectively) (P < 0.05). LIMITATION At low concentrations of Aβ40, dose-response associations with mortality differed between cohorts, possibly because of varying blood preparations used to measure Aβ40. CONCLUSION Circulating Aβ40 is a predictor of mortality and improves risk stratification of patients with NSTE-ACS over the GRACE score recommended by clinical guidelines. The clinical application of Aβ40 as a novel biomarker in NSTE-ACS should be further explored and validated. PRIMARY FUNDING SOURCE German Cardiac Society.
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Affiliation(s)
- Kimon Stamatelopoulos
- Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece (K.S., G.G., F.A.)
| | - Matthias Mueller-Hennessen
- University Hospital Heidelberg and German Center for Cardiovascular Research, Heidelberg, Germany (M.M., M.B., M.V., H.A.K., E.G.)
| | - Georgios Georgiopoulos
- Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece (K.S., G.G., F.A.)
| | - Marco Sachse
- Institute of Cardiovascular Regeneration at Goethe University Frankfurt and German Center for Cardiovascular Research, Frankfurt, Germany (M.S., A.G., S.D.)
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland (J.B., P.B., T.N., C.M.)
| | - Kateryna Sopova
- German Center for Cardiovascular Research and Goethe University Frankfurt, Frankfurt, Germany (K.S., A.M.Z.)
| | - Aikaterini Gatsiou
- Institute of Cardiovascular Regeneration at Goethe University Frankfurt and German Center for Cardiovascular Research, Frankfurt, Germany (M.S., A.G., S.D.)
| | - Carolin Amrhein
- Institute of Cardiovascular Regeneration at Goethe University Frankfurt, Frankfurt, Germany (C.A.)
| | - Moritz Biener
- University Hospital Heidelberg and German Center for Cardiovascular Research, Heidelberg, Germany (M.M., M.B., M.V., H.A.K., E.G.)
| | - Mehrshad Vafaie
- University Hospital Heidelberg and German Center for Cardiovascular Research, Heidelberg, Germany (M.M., M.B., M.V., H.A.K., E.G.)
| | - Fani Athanasouli
- Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece (K.S., G.G., F.A.)
| | | | - Konstantinos Pateras
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (K.P.)
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland, and University Heart Center Hamburg, Hamburg, Germany (R.T.)
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland (J.B., P.B., T.N., C.M.)
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland (J.B., P.B., T.N., C.M.)
| | - Stefanie Dimmeler
- Institute of Cardiovascular Regeneration at Goethe University Frankfurt and German Center for Cardiovascular Research, Frankfurt, Germany (M.S., A.G., S.D.)
| | - Hugo A Katus
- University Hospital Heidelberg and German Center for Cardiovascular Research, Heidelberg, Germany (M.M., M.B., M.V., H.A.K., E.G.)
| | - Andreas M Zeiher
- German Center for Cardiovascular Research and Goethe University Frankfurt, Frankfurt, Germany (K.S., A.M.Z.)
| | - Christian Mueller
- Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland (J.B., P.B., T.N., C.M.)
| | - Evangelos Giannitsis
- University Hospital Heidelberg and German Center for Cardiovascular Research, Heidelberg, Germany (M.M., M.B., M.V., H.A.K., E.G.)
| | - Konstantinos Stellos
- Cardiovascular Research Centre, Institute of Genetic Medicine, Newcastle University and Cardiothoracic Centre, Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (K.S.)
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21
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Comparison of SYNTAX score II efficacy with SYNTAX score and TIMI risk score for predicting in-hospital and long-term mortality in patients with ST segment elevation myocardial infarction. Int J Cardiovasc Imaging 2018. [PMID: 29541904 DOI: 10.1007/s10554-018-1333-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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22
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Viana MDS, Lopes F, Cerqueira Junior AMDS, Suerdieck JG, Silva ABD, Silva ACBD, Souza TMBD, Carvalhal MC, Rabelo MMN, Correia LCL. Incremental Prognostic Value of the Incorporation of Clinical Data Into Coronary Anatomy Data in Acute Coronary Syndromes: SYNTAX-GRACE Score. Arq Bras Cardiol 2017; 109:527-532. [PMID: 29160388 PMCID: PMC5783433 DOI: 10.5935/abc.20170160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/28/2017] [Indexed: 12/22/2022] Open
Abstract
Background When performing coronary angiography in patients with acute coronary syndrome
(ACS), the anatomical extent of coronary disease usually prevails in the
prognostic reasoning. It has not yet been proven if clinical data should be
accounted for in risk stratification together with anatomical data. Objective To test the hypothesis that clinical data increment the prognostic value of
anatomical data in patients with ACS. Methods Patients admitted with objective criteria for ACS and who underwent
angiography during hospitalization were included. Primary outcome was
defined as in-hospital cardiovascular death, and the prognostic value of the
SYNTAX Score (anatomical data) was compared to that of the SYNTAX-GRACE
Score, which resulted from the incorporation of the GRACE Score into the
SYNTAX score. The Integrated Discrimination Improvement (IDI) was calculated
to evaluate the SYNTAX-GRACE Score ability to correctly reclassify
information from the traditional SYNTAX model. Results This study assessed 365 patients (mean age, 64 ± 14 years; 58% male).
In-hospital cardiovascular mortality was 4.4%, and the SYNTAX Score was a
predictor of that outcome with a C-statistic of 0.81 (95% CI: 0.70 - 0.92; p
< 0.001). The GRACE Score was a predictor of in-hospital cardiac death
independently of the SYNTAX Score (p < 0.001, logistic regression). After
incorporation into the predictive model, the GRACE Score increased the
discrimination capacity of the SYNTAX Score from 0.81 to 0.92 (95% CI: 0.87
- 0.96; p = 0.04). Conclusion In patients with ACS, clinical data complement the prognostic value of
coronary anatomy. Risk stratification should be based on the
clinical-anatomical paradigm, rather than on angiographic data only.
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Affiliation(s)
| | - Fernanda Lopes
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil
| | | | | | | | | | | | | | | | - Luis Claudio Lemos Correia
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil.,Hospital São Rafael, Fundação Monte Tabor, Salvador, BA - Brazil
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23
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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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24
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Iannaccone M, D'Ascenzo F, Vadalà P, Wilton SB, Noussan P, Colombo F, Raposeiras Roubín S, Abu Assi E, González-Juanatey JR, Simao Henriques JP, Saucedo J, Kikkert WJ, Nuñez-Gil I, Ariza-Sole A, Song XT, Alexopoulos D, Liebetrau C, Kawaji T, Moretti C, Garbo R, Huczek Z, Nie SP, Fujii T, Correia LC, Kawashiri MA, García Acuña JM, Southern D, Alfonso E, Terol B, Garay A, Zhang D, Chen Y, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Giordana F, Kowara M, Filipiak K, Wang X, Yan Y, Fan JY, Ikari Y, Nakahashi T, Sakata K, Gaita F, Yamagishi M, Kalpak O, Kedev S. Prevalence and outcome of patients with cancer and acute coronary syndrome undergoing percutaneous coronary intervention: a BleeMACS substudy. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:631-638. [PMID: 28593789 DOI: 10.1177/2048872617706501] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence and outcome of patients with cancer that experience acute coronary syndrome (ACS) have to be determined. METHODS AND RESULTS The BleeMACS project is a multicentre observational registry enrolling patients with acute coronary syndrome undergoing percutaneous coronary intervention worldwide in 15 hospitals. The primary endpoint was a composite event of death and re-infarction after one year of follow-up. Bleedings were the secondary endpoint. 15,401 patients were enrolled, 926 (6.4%) in the cancer group and 14,475 (93.6%) in the group of patients without cancer. Patients with cancer were older (70.8±10.3 vs. 62.8±12.1 years, P<0.001) with more severe comorbidities and presented more frequently with non-ST-segment elevation myocardial infarction compared with patients without cancer. After one year, patients with cancer more often experienced the composite endpoint (15.2% vs. 5.3%, P<0.001) and bleedings (6.5% vs. 3%, P<0.001). At multiple regression analysis the presence of cancer was the strongest independent predictor for the primary endpoint (hazard ratio (HR) 2.1, 1.8-2.5, P<0.001) and bleedings (HR 1.5, 1.1-2.1, P=0.015). Despite patients with cancer generally being undertreated, beta-blockers (relative risk (RR) 0.6, 0.4-0.9, P=0.05), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (RR 0.5, 0.3-0.8, P=0.02), statins (RR 0.3, 0.2-0.5, P<0.001) and dual antiplatelet therapy (RR 0.5, 0.3-0.9, P=0.05) were shown to be protective factors, while proton pump inhibitors (RR 1, 0.6-1.5, P=0.9) were neutral. CONCLUSION Cancer has a non-negligible prevalence in patients with acute coronary syndrome undergoing percutaneous coronary intervention, with a major risk of cardiovascular events and bleedings. Moreover, these patients are often undertreated from clinical despite medical therapy seems to be protective. Registration:The BleeMACS project (NCT02466854).
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Affiliation(s)
- Mario Iannaccone
- 1 San Giovanni Bosco Hospital, Turin, Italy.,2 Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Italy
| | - Fabrizio D'Ascenzo
- 2 Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Italy
| | - Paolo Vadalà
- 2 Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Italy
| | | | | | | | | | - Emad Abu Assi
- 4 University Clinical Hospital, Santiago de Compostela, Spain
| | | | | | | | - Wouter J Kikkert
- 5 University Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - Xian-Tao Song
- 9 Beijing Anzhen Hospital, Capital Medical University, China
| | | | | | | | - Claudio Moretti
- 2 Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Italy
| | | | | | - Shao-Ping Nie
- 14 Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | | | | | - Masa-Aki Kawashiri
- 17 Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | | | | | | | - Belén Terol
- 17 Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | | | - Dongfeng Zhang
- 9 Beijing Anzhen Hospital, Capital Medical University, China
| | - Yalei Chen
- 9 Beijing Anzhen Hospital, Capital Medical University, China
| | | | - Neriman Osman
- 11 Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | | | | | - Francesca Giordana
- 2 Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Italy
| | | | | | - Xiao Wang
- 14 Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yan Yan
- 14 Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Jing-Yao Fan
- 14 Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yuji Ikari
- 15 Tokai University School of Medicine, Tokyo, Japan
| | - Takuya Nakahashi
- 17 Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenji Sakata
- 17 Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Fiorenzo Gaita
- 2 Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Italy
| | - Masakazu Yamagishi
- 17 Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Oliver Kalpak
- 18 University Clinic of Cardiology, Skopje, Macedonia
| | - Sasko Kedev
- 18 University Clinic of Cardiology, Skopje, Macedonia
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25
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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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26
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Wang G, Wang C, Zhang Y, Wang P, Ran C, Zhao L, Han L. Usefulness of the SYNTAX score II to predict 1-year outcome in patients with primary percutaneous coronary intervention. Coron Artery Dis 2017; 27:483-9. [PMID: 27171362 DOI: 10.1097/mca.0000000000000385] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the predictive effect of SYNTAX score II (SS-II) for the 1-year outcome in patients with ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention and whether SS-II improves the ability of anatomical and Logistic Clinical SYNTAX score and Global Registry of Acute Coronary Events to predict major adverse cardiac events (MACE). BACKGROUND SS-II can predict 1-year outcomes in patients with complex coronary artery disease. However, the prognostic value of SS-II for patients undergoing primary percutaneous coronary intervention remains unclear. MATERIALS AND METHODS A total of 477 patients were divided into three groups on the basis of SS-II [SS-II low tertile <20 (n=161), 20 ≤SS-II intermediate tertile ≤26 (n=145), and SS-II high tertile >26 (n=171)]. Kaplan-Meier methods were used to compare the MACE at the 1-year follow-up. RESULTS MACE was highest in the SS-II high tertile (21.1 vs. 10.3 vs. 5.5%, P<0.001), including all-cause mortality (11.7 vs. 4.1 vs. 2.5%, P=0.001), target vessel revascularization (7.6 vs. 4.1 vs. 1.8%, P=0.037), and recurrent MI (5.8 vs. 2.1 vs. 1.2%, P=0.035), compared with SS-II intermediate and low tertiles. In Cox multivariable analysis, SS-II was an independent predictor for MACE at 1 year. The receiver operating characteristic curve showed that SS-II had 60% sensitivity and 78% specificity for predicting 1-year MACE as a cut-off value of 27.5. The respective C-statistics of SS-II, anatomical, and Logistic Clinical SYNTAX score and Global Registry of Acute Coronary Events for MACE were 0.726, 0.587, 0.684, and 0.628 (P<0.05). CONCLUSION SS-II can predict 1-year clinical outcomes in patients with ST-segment elevation myocardial infarction and has an improved ability to predict MACE.
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Affiliation(s)
- Gang Wang
- Departments of aCardiology bCardiac Surgery, Cangzhou Central Hospital, Hebei Medical University cDepartment of Clinical Laboratory, Cangzhou People's Hospital, Canghou City, China
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27
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The value of the Clinical SYNTAX Score in predicting long-term prognosis in patients with ST-segment elevation myocardial infarction who have undergone primary percutaneous coronary intervention. Coron Artery Dis 2016; 27:135-42. [PMID: 26720108 DOI: 10.1097/mca.0000000000000332] [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] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Clinical SYNTAX Score (CSS) combines anatomical and clinical risk assessment. OBJECTIVES This study was designed to evaluate CSS as a predictor of prognosis in patients with ST-elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention (p-PCI). METHODS We evaluated 433 patients who were diagnosed with STEMI and underwent p-PCI. CSS was calculated by multiplying the anatomically derived SYNTAX score (Sx) by the modified age, creatinine, and ejection fraction score. Patients were divided into tertiles according to the CSS: CSS(Low)≤14 (n=141), 14<CSS(Mid)≤26 (n=144), and CSS(High)>26 (n=148). The primary endpoints were defined as all-cause mortality, myocardial infarction, and cerebrovascular events over 15 months' follow-up. RESULTS Primary endpoints were achieved in 9.2% of patients with CSS≤14, 12.5% of those with 14<CSS≤26, and 28.4% of those with CSS>26 (P<0.001). Kaplan-Meier analysis showed that the CSS>26 group had a significantly higher incidence of primary endpoints [P (log-rank)<0.001]. CSS>26 was identified as an independent predictor for all-cause mortality, myocardial infarction, and cerebrovascular events (hazard ratio 3.58, 95% confidence interval 1.68-7.60, P=0.001). Receiver operating characteristic analysis found areas under the curve of 0.66, 0.59, and 0.64 for CSS, Sx score, and age, creatinine, and ejection fraction score (P<0.001, P=0.01, P<0.001, respectively). CONCLUSION CSS may be better than the Sx score for predicting long-term prognosis in patients with STEMI undergoing p-PCI.
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28
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Shavadia J, Armstrong PW. Risk stratification in non-ST elevation acute coronary syndromes: searching for the right formula. Eur Heart J 2016; 37:3111-3113. [PMID: 26685972 DOI: 10.1093/eurheartj/ehv586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jay Shavadia
- Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Paul W Armstrong
- Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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29
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Xhepa E, Tada T, Kufner S, Ndrepepa G, Byrne RA, Kreutzer J, Ibrahim T, Tiroch K, Valgimigli M, Tölg R, Cassese S, Fusaro M, Schunkert H, Laugwitz KL, Mehilli J, Kastrati A. Long-term prognostic value of risk scores after drug-eluting stent implantation for unprotected left main coronary artery: A pooled analysis of the ISAR-LEFT-MAIN and ISAR-LEFT-MAIN 2 randomized clinical trials. Catheter Cardiovasc Interv 2016; 89:1-10. [DOI: 10.1002/ccd.26645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/01/2016] [Accepted: 06/04/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Erion Xhepa
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | - Tomohisa Tada
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | - Gjin Ndrepepa
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | - Robert A. Byrne
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | - Johanna Kreutzer
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | - Tareq Ibrahim
- Medizinische Klinik, Klinikum rechts der Isar; Technische Universität Muenchen; Munich Germany
| | - Klaus Tiroch
- Helios Clinic Wuppertal; Med. Klinik 3 - Kardiologie Wuppertal Germany
| | | | - Ralf Tölg
- Herzzentrum, Kardiologie, Segeberger Kliniken, Bad Segeberg; Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance; Munich Germany
| | - Karl L. Laugwitz
- Medizinische Klinik, Klinikum rechts der Isar; Technische Universität Muenchen; Munich Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance; Munich Germany
| | - Julinda Mehilli
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance; Munich Germany
- Klinikum der Universität München; Medizinische Klinik I; Munich Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance; Munich Germany
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30
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Comparison of long-term prognostic value of baseline SYNTAX and clinical SYNTAX scores in ST-segment elevation myocardial infarction patients with multivessel disease. Coron Artery Dis 2016; 27:311-8. [DOI: 10.1097/mca.0000000000000365] [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] [Indexed: 11/25/2022]
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31
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Martín-Reyes R, Franco-Peláez JA, Lorenzo Ó, González-Casaus ML, Pello AM, Aceña Á, Carda R, Martín-Ventura JL, Blanco-Colio L, Martín-Mariscal ML, Martínez-Milla J, Villa-Bellosta R, Piñero A, Navarro F, Egido J, Tuñón J. Plasma Levels of Monocyte Chemoattractant Protein-1, n-Terminal Fragment of Brain Natriuretic Peptide and Calcidiol Are Independently Associated with the Complexity of Coronary Artery Disease. PLoS One 2016; 11:e0152816. [PMID: 27171378 PMCID: PMC4865225 DOI: 10.1371/journal.pone.0152816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/18/2016] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives We investigated the relationship of the Syntax Score (SS) and coronary artery calcification (CAC), with plasma levels of biomarkers related to cardiovascular damage and mineral metabolism, as there is sparse information in this field. Methods We studied 270 patients with coronary disease that had an acute coronary syndrome (ACS) six months before. Calcidiol, fibroblast growth factor-23, parathormone, phosphate and monocyte chemoattractant protein-1 [MCP-1], high-sensitivity C-reactive protein, galectin-3, and N-terminal pro-brain natriuretic peptide [NT-proBNP] levels, among other biomarkers, were determined. CAC was assessed by coronary angiogram as low-grade (0–1) and high-grade (2–3) calcification, measured with a semiquantitative scale ranging from 0 (none) to 3 (severe). For the SS study patients were divided in SS<14 and SS≥14. Multivariate linear and logistic regression analyses were performed. Results MCP-1 predicted independently the SS (RC = 1.73 [95%CI = 0.08–3.39]; p = 0.040), along with NT-proBNP (RC = 0.17 [95%CI = 0.05–0.28]; p = 0.004), male sex (RC = 4.15 [95%CI = 1.47–6.83]; p = 0.003), age (RC = 0.13 [95%CI = 0.02–0.24]; p = 0.020), hypertension (RC = 3.64, [95%CI = 0.77–6.50]; p = 0.013), hyperlipidemia (RC = 2.78, [95%CI = 0.28–5.29]; p = 0.030), and statins (RC = 6.12 [95%CI = 1.28–10.96]; p = 0.013). Low calcidiol predicted high-grade calcification independently (OR = 0.57 [95% CI = 0.36–0.90]; p = 0.013) along with ST-elevation myocardial infarction (OR = 0.38 [95%CI = 0.19–0.78]; p = 0.006), diabetes (OR = 2.35 [95%CI = 1.11–4.98]; p = 0.028) and age (OR = 1.37 [95%CI = 1.18–1.59]; p<0.001). During follow-up (1.79 [0.94–2.86] years), 27 patients developed ACS, stroke, or transient ischemic attack. A combined score using SS and CAC predicted independently the development of the outcome. Conclusions MCP-1 and NT-proBNP are independent predictors of SS, while low calcidiol plasma levels are associated with CAC. More studies are needed to confirm these data.
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Affiliation(s)
- Roberto Martín-Reyes
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- * E-mail:
| | | | - Óscar Lorenzo
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
| | | | - Ana María Pello
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Rocío Carda
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - José Luis Martín-Ventura
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
| | - Luis Blanco-Colio
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Juan Martínez-Milla
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Ricardo Villa-Bellosta
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Antonio Piñero
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Felipe Navarro
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Jesús Egido
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
- Department of Nephrology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- CIBERDEM, Madrid, Spain
| | - José Tuñón
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
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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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Abstract
This article summarizes treatment alternatives for coronary bifurcation lesions. It also reviews current definitions and classifications pertaining to bifurcation lesions and provides an overview of the impact of bifurcation lesions on clinical outcomes.
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Affiliation(s)
- Björn Redfors
- Clinical Trial Center, Cardiovascular Research Foundation, 111 East 59th Street, New York, NY 10022, USA; Department of Cardiology, Sahlgrenska University Hospital, Bruna Straket 16, 413 45 Gothenburg, Sweden
| | - Philippe Généreux
- Clinical Trial Center, Cardiovascular Research Foundation, 111 East 59th Street, New York, NY 10022, USA; Department of Cardiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400, boul. Gouin Ouest, Montréal, Québec H4J 1C5, Canada.
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Chen J, Tang B, Lin Y, Ru Y, Wu M, Wang X, Chen Q, Chen Y, Wang J. Validation of the Ability of SYNTAX and Clinical SYNTAX Scores to Predict Adverse Cardiovascular Events After Stent Implantation: A Systematic Review and Meta-Analysis. Angiology 2015; 67:820-8. [PMID: 26614789 DOI: 10.1177/0003319715618803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To compare the predicative ability of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and clinical SYNTAX scores for major adverse cardiac events (MACEs) after stent implantation in patients with coronary artery disease (CAD). Studies were identified by electronic and manual searches. Twenty-six studies were included in the meta-analysis. The pooled C-statistics of SYNTAX score for 1- and 5-year all-cause mortality (ACM) were 0.65 (95% confidence interval [CI]: 0.61-0.68) and 0.62 (95% CI: 0.59-0.65), respectively, with weak heterogeneity. The 1- and 5-year ACM pooled C-statistics for clinical SYNTAX scores were significantly higher at 0.77 and 0.71, respectively (Ps < .05). Both scoring systems predicted 1- and 5-year MACE equally well. The pooled risk ratio of the SYNTAX score for predicting 1-year ACM per unit was 1.04 (95% CI: 1.03-1.05). Calibration analysis indicated SYNTAX scores overestimated the risk of major adverse cardiac and cerebrovascular events in each risk stratum. The SYNTAX score demonstrated minimal discrimination in predicting 1- or 5-year adverse cardiovascular events after percutaneous coronary intervention in patients with CAD. The clinical SYNTAX score could further improve the predictive capability for ACM but not MACE.
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Affiliation(s)
- JiaYuan Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Buzhou Tang
- Intelligent Computing Research Center, Harbin Institute of Technology Shenzhen Graduate School, Shenzhen, China
| | - YongQing Lin
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Ying Ru
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - MaoXiong Wu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Xiaolong Wang
- Intelligent Computing Research Center, Harbin Institute of Technology Shenzhen Graduate School, Shenzhen, China
| | - Qingcai Chen
- Intelligent Computing Research Center, Harbin Institute of Technology Shenzhen Graduate School, Shenzhen, China
| | - YangXin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - JingFeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
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Bypass Grafting Versus Percutaneous Intervention-Which Is Better in Multivessel Coronary Disease: Lessons From SYNTAX and Beyond. Prog Cardiovasc Dis 2015; 58:316-34. [PMID: 26529569 DOI: 10.1016/j.pcad.2015.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The landmark Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) Trial has aided in reducing the area of uncertainty in decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with complex coronary artery disease. As part of the SYNTAX Trial, quantification of the coronary artery disease burden was prospectively undertaken by the Heart Team - consisting of at least an interventional cardiologist and cardiac surgeon - utilising the anatomical SYNTAX Score (www.syntaxscore.com) as a clinical tool in order to agree that equivalent anatomical revascularisation could be achieved. The anatomical SYNTAX Score is now advocated in both European and US revascularisation guidelines to guide decision-making between CABG and PCI as part of the SYNTAX pioneered Heart Team approach. In addition, the SYNTAX Trial has lead to the development and validation of the SYNTAX Score II, in which the anatomical SYNTAX Score was augmented with clinical variables, to allow for more objective and tailored decision making for the individual patient. Prospective validation of the SYNTAX Score II tool is currently ongoing in the SYNTAX II (ClinicalTrials.gov Identifier: NCT02015832) and EXCEL (ClinicalTrials.gov identifier: NCT01205776) trials. The present paper presents lessons learned from SYNTAX, including the development and/or validation of several SYNTAX based clinical tools, and the potential implications for current and future clinical practice.
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He JQ, Yu XP, Peng C, Li Q, Luo YW, Gao YC, Zhang XL, Wu CY, Zhao H, Zhang YC, Liu JH, Lyu SZ, Chen F. Predictive Ability of the SYNergy Between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery Score II for Long-term Mortality in Patients with Three-vessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention Treated with Second-generation Drug-eluting Stents. Chin Med J (Engl) 2015; 128:2176-82. [PMID: 26265610 PMCID: PMC4717991 DOI: 10.4103/0366-6999.162510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery Score II (SS-II) can well predict 4-year mortality in patients with complex coronary artery disease (CAD), and guide decision-making between coronary artery bypass graft surgery and percutaneous coronary intervention (PCI). However, there is lack of data regarding the utility of the SS-II in patients with three-vessel CAD undergoing PCI treated with second-generation drug-eluting stents (DES). The purpose of the present study was to evaluate the ability of the SS-II to predict long-term mortality in patients with three-vessel CAD undergoing PCI with second-generation DES. Methods: Totally, 573 consecutive patients with de novo three-vessel CAD who underwent PCI with second-generation DES were retrospectively studied. According to the tertiles of the SS-II, the patients were divided into three groups: The lowest SS-II tertile (SS-II ≤20), intermediate SS-II tertile (SS-II of 21–31), and the highest SS-II tertile (SS-II ≥32). The survival curves of the different groups were estimated by the Kaplan–Meier method. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the relationship between the SS-II and 5-year mortality. The performance of the SS-II with respect to predicting the rate of mortality was studied by calculating the area under the receiver operator characteristic (ROC) curve. The predictive ability of the SS-II for 5-year mortality was evaluated and compared with the SS alone. Results: The overall SS-II was 27.6 ± 9.0. Among patients in the lowest, intermediate and the highest SS-II tertiles, the 5-year rates of mortality were 1.6%, 3.2%, and 8.6%, respectively (P = 0.003); the cardiac mortality rates were 0.5%, 1.9%, and 5.2%, respectively (P = 0.014). By multivariable analysis, adjusting for the potential confounders, the SS-II was an independent predictor of 5-year mortality (hazard ratio: 2.45, 95% confidence interval: 1.38–4.36; P = 0.002). The SS-II demonstrated a higher predictive accuracy for 5-year mortality compared with the SS alone (the area under the ROC curve was 0.705 and 0.598, respectively). Conclusion: The SS-II is an independent predictor of 5-year mortality in patients with three-vessel CAD undergoing PCI treated with second-generation DES, and demonstrates a superior predictive ability over the SS alone.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Fang Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Institution of Beijing Heart Lung and Vascular Disease, Beijing 100029, China
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Ozturk D, Celik O, Erturk M, Kalkan AK, Uzun F, Akturk IF, Akin F, Yildirim A. Utility of the Logistic Clinical Syntax Score in the Prediction of Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention. Can J Cardiol 2015; 32:240-6. [PMID: 26255218 DOI: 10.1016/j.cjca.2015.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/09/2015] [Accepted: 05/10/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The Logistic Clinical Syntax Score (log CSS) is a combined risk scoring system that includes clinical and anatomic parameters; it has been found to be effective for the prediction of mortality in patients with ST-elevation myocardial infarction (STEMI). The aim of the present study was to assess whether the log CSS was associated with the development of contrast-induced nephropathy (CIN) in patients who underwent primary percutaneous coronary intervention (pPCI). METHODS A total of 930 patients with STEMI undergoing pPCI between January 2012 and August 2013 were included prospectively. The patients were grouped according to the development of CIN. Either an absolute serum creatinine level ≥ 0.5 mg/dL or a 25% increase in the serum creatinine level compared with the baseline level within 48 hours after the administration of contrast medium was defined as CIN. RESULTS The Synergy Between Percutaneous Coronary Interventions With Taxus and Cardiac Surgery score (SYNTAX [SS]) and log CSS were higher in patients with CIN than in those without. In the multivariate analysis, log CSS (odds ratio, 1.405, 95% confidence interval, 1.318-1.497; P < 0.001), hemoglobin, and contrast volume were found to be independent predictors of CIN. In the receiver operating characteristic analysis, a log CSS > 9.5 had a 74.5% sensitivity and a 90.5% specificity for predicting CIN, with an area under the curve (AUC) of 0.892, whereas an SS > 18.5 had a 64% sensitivity, a 58.1% specificity, and an AUC of 0.625 (0.892 vs 0.625; P < 0.001). A log CSS > 9.5 was associated with in-hospital and long-term mortality, reinfarction, revascularization, and in-hospital hemodialysis (P < 0.001 for each). CONCLUSIONS The log CSS may improve the accuracy of risk stratification for the development of CIN in patients undergoing pPCI.
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Affiliation(s)
- Derya Ozturk
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Omer Celik
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Kemal Kalkan
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatih Uzun
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Faruk Akturk
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatih Akin
- Department of Cardiology, Mugla Sikti Kocman University Medical Faculty, Mugla, Turkey
| | - Aydin Yildirim
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Ozturk D, Celık O, Cakmak HA, Akın F, Aslan S, Enhos A, Tasbulak O, Ayca B, Erkanlı K, Bakır İ. Usefulness of the Logistic Clinical Syntax Score in Prediction of Saphenous Vein Graft Failure in Patients Undergoing Coronary Artery Bypass Grafting. Angiology 2014; 66:714-20. [DOI: 10.1177/0003319714557539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We investigated the association between the preoperative logistic clinical syntax score (log CSS), saphenous vein graft (SVG) patency, and major adverse cardiac and cerebrovascular events (MACCEs) after coronary artery bypass surgery (CABG). Of 1875 patients undergoing isolated CABG between 2009 and 2011, 267 patients, who later underwent coronary angiography, were included in the study. The primary end point was at least 1 graft occlusion on the follow-up coronary angiogram. The secondary end point was a composite of MACCE. In multivariate analysis, log CSS was found as a strong predictor of SVG failure (odds ratio [OR] 0.66, 95% confidence interval [CI]: 0.46-0.94, P = .02; and OR: 2.21, 95% CI: 1.02-4.75, P = .04, respectively): log CSS was also associated with MACCE ( P = .001 and P < .001, respectively). The addition of clinical parameters to the anatomical SYNTAX score, termed as “log CSS”, augmented the accuracy and reliability of the prediction of SVG failure and MACCE in patients undergoing CABG.
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Affiliation(s)
- Derya Ozturk
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Omer Celık
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | | | - Fatih Akın
- Department of Cardiology, Medical Faculty, Muğla Sıtkı Kocman Unıversıty, Muğla, Turkey
| | - Serkan Aslan
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Asım Enhos
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Omer Tasbulak
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Burak Ayca
- Department of Cardiology, Bağcilar Education and Research Hospital, Istanbul, Turkey
| | - Korhan Erkanlı
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - İhsan Bakır
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Xu B, Généreux P, Yang Y, Leon MB, Xu L, Qiao S, Wu Y, Yan H, Chen J, Zhao Y, Zhao Y, Palmerini T, Stone GW, Gao R. Validation and Comparison of the Long-Term Prognostic Capability of the SYNTAX Score-II Among 1,528 Consecutive Patients Who Underwent Left Main Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2014; 7:1128-37. [DOI: 10.1016/j.jcin.2014.05.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 12/24/2022]
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Combination of pulse wave velocity with clinical factors as a promising tool to predict major adverse cardiac events after percutaneous coronary intervention. J Cardiol 2014; 65:318-23. [PMID: 25048178 DOI: 10.1016/j.jjcc.2014.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/19/2014] [Accepted: 06/20/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND The relationship between aortic stiffness and coronary artery disease has been proven. Logistic Clinical SYNTAX score (LogCSS), which combined the anatomical evaluation of coronary artery disease and three clinical factors (age, left ventricular ejection fraction, and creatinine clearance), showed improved predictive value for cardiovascular events in patients after percutaneous coronary intervention (PCI). The combination of pulse wave velocity (PWV) and clinical factors may show equivalent predictive value. METHODS Three hundred and seventy-six patients who were diagnosed with non-ST-segment elevation coronary syndrome (ACS) and showed at least one ≥50% angiographic stenosis in a major coronary artery were enrolled. The Clinical PWV score was calculated by assigning points to different levels of age, creatinine clearance, left ventricular ejection fraction, and carotid-femoral PWV (cfPWV). The points for cfPWV were determined based on the cutoff values of quintiles (model 1) or the relationship between cfPWV and SYNTAX scores (model 2). The predictive values of LogCSS and Clinical PWV score for 3-year major adverse cardiac events (MACE), which were defined as all-cause death, nonfatal myocardial infarction, and nonfatal target vessel revascularization, were analyzed in 298 patients undergoing PCI. RESULTS The Clinical PWV score based on model 2 demonstrated a similar predictive ability for 3-year MACE compared with LogCSS (AUC 0.72 vs. 0.75; p=0.11). The AUC of LogCSS was significantly higher than the AUC of Clinical PWV score based on model 1 (AUC=0.70, p=0.03). Compared with cfPWV in isolation (AUC=0.61), Clinical PWV score from model 2 showed significantly better predictive power (p=0.03). CONCLUSION Combination of PWV with age, creatinine clearance, and left ventricular ejection fraction appears to be a promising tool to predict MACE after PCI in patients with ACS.
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Yadav M, Généreux P, Palmerini T, Caixeta A, Madhavan MV, Xu K, Brener SJ, Mehran R, Stone GW. SYNTAX score and the risk of stent thrombosis after percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes: An ACUITY trial substudy. Catheter Cardiovasc Interv 2014; 85:1-10. [DOI: 10.1002/ccd.25396] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 12/22/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Mayank Yadav
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/ Columbia University Medical Center; New York New York
| | - Philippe Généreux
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/ Columbia University Medical Center; New York New York
- Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montréal Québec Canada
| | | | - Adriano Caixeta
- Hospital Israelita Albert Einstein and Escola Paulista de Medicina; Universidade Federal de Sao Paulo; Brazil
| | - Mahesh V. Madhavan
- New York-Presbyterian Hospital/ Columbia University Medical Center; New York New York
| | - Ke Xu
- Cardiovascular Research Foundation; New York New York
| | | | | | - Gregg W. Stone
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/ Columbia University Medical Center; New York New York
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Iqbal J, Vergouwe Y, Bourantas CV, Klaveren DV, Zhang YJ, Campos CM, García-García HM, Morel MA, Valgimigli M, Windecker S, Steyerberg EW, Serruys PW. Predicting 3-Year Mortality After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2014; 7:464-70. [DOI: 10.1016/j.jcin.2014.02.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/04/2014] [Accepted: 02/24/2014] [Indexed: 11/27/2022]
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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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Caixeta A, Généreux P, Palmerini T, Lansky AJ, Mehran R, Dangas GD, Xu K, Brener SJ, Stone GW. Prognostic utility of the SYNTAX score in patients with single versus multivessel disease undergoing percutaneous coronary intervention (from the Acute Catheterization and Urgent Intervention Triage StrategY [ACUITY] trial). Am J Cardiol 2014; 113:203-10. [PMID: 24176063 DOI: 10.1016/j.amjcard.2013.08.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 08/19/2013] [Accepted: 08/19/2013] [Indexed: 11/25/2022]
Abstract
The SYNergy between percutaneous intervention with TAXus drug-eluting stents and cardiac surgery (SYNTAX) score (SS) is an effective angiographic predictor of clinical outcomes in patients with multivessel coronary artery disease (MVD) undergoing percutaneous coronary intervention. It is not known whether this relation is independent of the number of diseased vessels. The aim of the present study was to assess the relation between the SS and major adverse cardiac events (MACE) in patients with single-vessel disease (SVD) and MVD undergoing percutaneous coronary intervention. In the ACUITY trial, the SS was determined in 2,627 patients undergoing percutaneous coronary intervention. The relation between the SS and the 1-year clinical outcomes was assessed according to SS tertiles: <5 (n = 441), ≥5 but <10 (n = 525), and ≥10 (n = 495) for SVD and <10 (n = 361), ≥10 but <18 (n = 401), and ≥18 (n = 404) for MVD. At 1 year of follow-up, the rate of MACE was 16.8%, 24.7%, and 23.7% for patients with MVD in the first, second and third tertiles, respectively (p = 0.02). The corresponding rates for those with SVD was 13.3%, 15.3%, and 19.1% (p = 0.01). In the patients with MVD, the SS independently predicted 1-year MACE (hazard ratio 1.02, 95% confidence interval 1.01 to 1.03; p = 0.002), myocardial infarction (hazard ratio 1.02, 95% confidence 1.00 to 1.04; p = 0.02), and cardiac death (hazard ratio 1.05, 95% confidence interval 1.02 to 1.09; p = 0.005). In patients with SVD, the SS independently predicted 1-year MACE (hazard ratio 1.03, 95% confidence interval 1.01 to 1.05; p = 0.0009) and myocardial infarction (hazard ratio 1.05, 95% confidence interval 1.02 to 1.07; p = 0.002). In the overall study cohort, the SS was an independent predictor of MACE and death, and MVD (vs SVD) was not. In conclusion, the SS is a useful angiographic predictive tool for patients with SVD and MVD.
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Yadav M, Palmerini T, Caixeta A, Madhavan MV, Sanidas E, Kirtane AJ, Stone GW, Généreux P. Prediction of Coronary Risk by SYNTAX and Derived Scores. J Am Coll Cardiol 2013; 62:1219-1230. [DOI: 10.1016/j.jacc.2013.06.047] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 06/05/2013] [Accepted: 06/25/2013] [Indexed: 11/26/2022]
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Serruys PW, Farooq V, Kalesan B, de Vries T, Buszman P, Linke A, Ischinger T, Klauss V, Eberli F, Wijns W, Morice MC, Di Mario C, Corti R, Antoni D, Sohn HY, Eerdmans P, Rademaker-Havinga T, van Es GA, Meier B, Jüni P, Windecker S. Improved Safety and Reduction in Stent Thrombosis Associated With Biodegradable Polymer-Based Biolimus-Eluting Stents Versus Durable Polymer-Based Sirolimus-Eluting Stents in Patients With Coronary Artery Disease. JACC Cardiovasc Interv 2013; 6:777-89. [DOI: 10.1016/j.jcin.2013.04.011] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
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Abstract
The SYNTAX Score (http://www.syntaxscore.com) has established itself as an anatomical based tool for objectively determining the complexity of coronary artery disease and guiding decision-making between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). Since the landmark SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) Trial comparing CABG with PCI in patients with complex coronary artery disease (unprotected left main or de novo three vessel disease), numerous validation studies have confirmed the clinical validity of the SYNTAX Score for identifying higher-risk subjects and aiding decision-making between CABG and PCI in a broad range of patient types. The SYNTAX Score is now advocated in both the European and US revascularisation guidelines for decision-making between CABG and PCI as part of a SYNTAX-pioneered heart team approach. Since establishment of the SYNTAX Score, widening clinical applications of this clinical tool have emerged. The purpose of this review is to systematically examine the widening applications of tools based on the SYNTAX Score: (1) by improving the diagnostic accuracy of the SYNTAX Score by adding a functional assessment of lesions; (2) through amalgamation of the anatomical SYNTAX Score with clinical variables to enhance decision-making between CABG and PCI, culminating in the development and validation of the SYNTAX Score II, in which objective and tailored decisions can be made for the individual patient; (3) through assessment of completeness of revascularisation using the residual and post-CABG SYNTAX Scores for PCI and CABG patients, respectively. Finally, the future direction of the SYNTAX Score is covered through discussion of the ongoing development of a non-invasive, functional SYNTAX Score and review of current and planned clinical trials.
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Affiliation(s)
- Vasim Farooq
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, , Rotterdam, The Netherlands
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