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Syntax score predicts clinical outcome in patients with three-vessel coronary artery disease undergoing percutaneous
Ji-Qiang He1, Yue-Chun Gao, Xian-Peng Yu
1Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University & Institution of Beijing Heart Lung and Vascular Disease, Beijing 100029, China.
Insights
The Syntax score effectively predicts major adverse cardiac and cerebrovascular events (MACCE) in patients with 3-vessel coronary artery disease undergoing percutaneous coronary intervention (PCI). Higher scores indicate increased risk, aiding in patient stratification.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- The Syntax score is a validated angiographic tool for assessing coronary artery disease (CAD) complexity.
- It aids in selecting patients and stratifying risk for revascularization procedures.
- Its prognostic value in percutaneous coronary intervention (PCI) for 3-vessel disease requires further validation.
Purpose of the Study:
- To evaluate the predictive role of the Syntax score for long-term major adverse cardiac and cerebrovascular events (MACCE).
- To assess MACCE incidence in patients with 3-vessel CAD undergoing PCI.
Main Methods:
- 203 patients with de novo 3-vessel CAD undergoing PCI with sirolimus-eluting stents were analyzed.
- Angiograms were scored using the Syntax score and patients stratified into tertiles.
- Kaplan-Meier survival, Cox regression, and ROC curve analyses were used to assess MACCE prediction over 1 year.
Main Results:
- The Syntax score significantly predicted MACCE risk (HR 1.07/U increase, P < 0.001).
- The highest Syntax score tertile showed a significantly higher MACCE rate (17.9%) compared to the lowest (1.4%) and intermediate (6.2%) tertiles.
- After adjustment, the Syntax score remained a significant predictor (adjusted HR 1.12/U increase, P < 0.001), with an AUC of 0.77.
Conclusions:
- The Syntax score is a valuable predictor of MACCE in patients with 3-vessel disease undergoing PCI.
- The study confirms the prognostic utility of the Syntax score in this patient population.
- An optimal cutoff of 29.5 was identified for predicting MACCE.
Background:
The Syntax score was recently developed as a comprehensive, angiographic tool grading the complexity of coronary artery disease (CAD). It aims to assist in patient selection and risk stratification of patients with extensive CAD undergoing revascularization. However, the prognostic value of the Syntax score in patients undergoing percutaneous coronary intervention (PCI) has not been validated. The aim of this study was to evaluate its role in predicting long-term incidences of major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing PCI for 3-vessel disease.
Methods:
Two hundred and three consecutive patients with de novo 3-vessel CAD undergoing PCI with sirolimus-eluting stents were studied. Their angiograms were scored according to the Syntax score. The patients were divided into tertiles according to the Syntax score: lowest Syntax score tertile (Syntax score ≤ 22), intermediate Syntax score tertile (Syntax score of 23 to 32), and the highest Syntax score tertile (Syntax score ≥ 33). During the 1-year follow-up, the MACCE-free survival curves were estimated by the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the relation between the Syntax score and the incidence of MACCE. Performance of the Syntax score was studied with respect to predicting the rate of MACCE by receiver operator characteristic (ROC) curves with an area under the curve.
Results:
The overall Syntax score ranged from 6 to 66 with mean ± standard deviation of 27.9 ± 12.6 and a median of 26. At 1 year, the Syntax score significantly predicted the risk of MACCE (HR 1.07/U increase, 95%CI 1.04 to 1.11, P < 0.001). The rate of MACCE was significantly increased among patients in the highest Syntax score tertile (17.9%) as compared with those with the lowest Syntax score tertile (1.4%, P < 0.001) or intermediate Syntax score tertile (6.2%, P = 0.041). After the adjustment for all potential confounders, the Syntax score remained a significant predictor of the rate of MACCE (adjusted HR 1.12/U increase, 95%CI 1.05 to 1.20, P < 0.001). The Syntax score accurately predicted MACCE with an area under the receiver operator curve of 0.77 (95%CI 0.65 to 0.90, P < 0.001). A Syntax score of 29.5 was identified as the optimal cutoff to predict MACCE with a sensitivity of 82.4% and specificity of 65.6%.
Conclusion:
The Syntax score predicts the risk of MACCE in patients with 3-vessel disease undergoing PCI.
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