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Angiographic score assessment improves cardiovascular risk prediction: the clinical value of SYNTAX and Gensini
Christoph Sinning1, Lars Lillpopp, Sebastian Appelbaum
1Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
Insights
The Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score and Gensini score can predict long-term cardiovascular events in coronary artery disease (CAD) patients. Combining these scores with clinical data improves prognostic accuracy for better patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Disease Research
Background:
- Coronary artery disease (CAD) severity is linked to cardiovascular outcomes.
- Assessing long-term prognosis in CAD patients is crucial for effective management.
- The Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score and Gensini score reflect CAD complexity and cardiovascular event risk.
Purpose of the Study:
- To evaluate the long-term prognostic value of the SYNTAX and Gensini scores in a large cohort of CAD patients.
- To determine if these scores, alone or combined with clinical variables, can predict cardiovascular events over an 8-year follow-up period.
Main Methods:
- Analysis of the AtheroGene cohort (N = 1,974) including 22.6% women.
- Determination of CAD complexity using SYNTAX and Gensini scores.
- Long-term follow-up (median 5.4 years, up to 8 years) for non-fatal myocardial infarction and cardiovascular death.
- Cox regression analysis and C-index calculation to assess predictive performance.
- Net reclassification index used to evaluate improvement in event discrimination.
Main Results:
- Both SYNTAX and Gensini scores were significantly associated with increased risk of cardiovascular events (HR 1.5 and 1.41, respectively).
- The SYNTAX score alone had a C-index of 0.62, which increased to 0.67 when clinical variables were added.
- Similar improvements in predictive accuracy were observed for the Gensini score.
- The combination of scores with clinical variables and biomarkers enhanced event discrimination by over 30%.
Conclusions:
- The SYNTAX and Gensini scores, when used with clinical variables, can effectively predict cardiovascular prognosis in CAD patients.
- These scores offer valuable prognostic information for long-term follow-up, up to 8 years.
- Integrating these complexity scores into clinical practice can aid in risk stratification and management of CAD.
Background:
Severity of coronary artery disease (CAD) is related to cardiovascular outcome. We aimed to assess the long-term follow-up depending on Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) and Gensini score for prognosis. Both scores increase with complexity and thus reflect risk of cardiovascular events.
Methods And Results:
We determined complexity and extent of CAD by the SYNTAX and Gensini score in the AtheroGene cohort (N = 1,974, with 22.6 % women). The endpoint was non-fatal myocardial infarction (N = 132) and cardiovascular death (N = 159) over a median follow-up of 5.4 (Q1: 5.23/Q3: 5.57) years up to 8 years maximum (follow-up rate 99.4%). For SYNTAX score, the following distribution was used: low (≤22, N = 1,404), medium (23-32, N = 314), high score (>32, N = 256). Gensini score was split into thirds. Cox regression analysis showed a hazard ratio (HR) of 1.5 (95% confidence interval 1.16-1.95; p = 0.0024) for the log transformed SYNTAX score in a fully adjusted model and a HR of 1.41 (95% CI 1.13-1.77; p = 0.0025) for the Gensini score. The SYNTAX score alone had a C-index of 0.62, whereas adding clinical variables increased the C-index to 0.67. Similar results were obtained for the Gensini score. Regarding the SYNTAX score using net reclassification index, discrimination of events and non-events was enhanced by 37.2% in a model of clinical variables and biomarkers and by 31.8% for the Gensini score.
Conclusion:
The SYNTAX and Gensini score in combination with clinical variables could be used to predict the cardiovascular prognosis during a long-term follow-up of up to 8 years in CAD patients.
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