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z Scores and Area Under the Curve01:17

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z scores are the standardized values obtained after converting a normal distribution into a standard normal distribution. A z score is measured in units of the standard deviation. The z score tells you how many standard deviations the value x is above (to the right of) or below (to the left of) the mean, μ. Values of x that are larger than the mean have positive z scores, and values of x that are smaller than the mean have negative z scores. If x equals the mean, then x has a z score of...
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SYNTAX Score and Long-Term Outcomes: The BARI-2D Trial.

Fumiaki Ikeno1, Maria Mori Brooks2, Kaori Nakagawa1

  • 1Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.

Journal of the American College of Cardiology
|January 28, 2017
PubMed
Summary
This summary is machine-generated.

Higher SYNTAX scores in patients with diabetes and stable ischemic heart disease predict more major cardiovascular events. Revascularization, particularly coronary artery bypass graft surgery, showed better outcomes for those with higher scores compared to medical therapy.

Keywords:
angiographycoronary diseaseischemiaprognosisstentssurgery

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Coronary disease extent impacts outcomes and revascularization effectiveness (CABG vs. PCI).
  • The SYNTAX score quantifies coronary disease complexity.
  • SYNTAX score utility in predicting outcomes in diabetic patients requires further investigation.

Purpose of the Study:

  • To evaluate if SYNTAX scores predict outcomes in the BARI-2D trial.
  • To determine if SYNTAX scores predict revascularization effectiveness versus medical therapy.
  • To analyze SYNTAX score impact on major cardiovascular events in diabetic patients.

Main Methods:

  • Retrospective calculation of baseline SYNTAX scores for 1,550 BARI-2D patients without prior revascularization.
  • Angiographic investigators masked to patient data and outcomes.
  • Primary outcome: 5-year composite of death, myocardial infarction, and stroke.

Main Results:

  • Mid/high SYNTAX scores (≥23) correlated with increased major cardiovascular events (HR: 1.36, p=0.01).
  • Coronary artery bypass graft (CABG) patients had higher SYNTAX scores (36% mid/high) than percutaneous coronary intervention (PCI) patients (13%).
  • Revascularization (CABG and PCI) did not significantly differ from medical therapy for low SYNTAX scores (≤22). However, for mid/high SYNTAX scores, CABG showed improved outcomes (15.3% vs. 30.3%, p=0.02), unlike PCI (35.6% vs. 26.5%, p=0.12).

Conclusions:

  • In diabetic patients with stable ischemic heart disease, elevated SYNTAX scores predict higher major cardiovascular event rates.
  • Revascularization, especially CABG, demonstrated more favorable outcomes compared to medical therapy in patients with high SYNTAX scores.
  • SYNTAX score is a valuable tool for risk stratification and guiding treatment decisions in diabetic patients with coronary artery disease.