Combined anatomical and clinical factors for the long-term risk stratification of patients undergoing percutaneous coronary intervention: the Logistic Clinical SYNTAX score

Farooq, Vasim; Vergouwe, Yvonne; Räber, Lorenz; Vranckx, Pascal; García‐García, Héctor M.; Diletti, Roberto; Kappetein, Arie Pieter; Morel, Marie Angèle; Vries, Ton de; Swart, Michael; Valgimigli, Marco; Dawkins, Keith D.; Windecker, Stephan; Steyerberg, Ewout W.; Serruys, Patrick W.

doi:10.1093/eurheartj/ehs295

Cited by 148 publications

(121 citation statements)

References 54 publications

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“…1,[13][14][15][16][17][18] However, one of the most significant limitations of the SS is the omission of clinical variables in its calculation, which has been identified as a major effect in its capacity to accurately stratify patients with complex CAD. [19][20][21] The SS-II, by incorporating both the anatomic SS and clinical variables theoretically ensures a more accurate and individualized clinical outcome prediction. However, a limited number of studies have assessed the power of the SS-II.…”

Section: Discussionmentioning

confidence: 99%

SYNTAX Score-II Predicts Long-Term Mortality in Patients Who Underwent Left Main Percutaneous Coronary Intervention Treated With Second-Generation Drug-Eluting Stents

Zhao

et al. 2017

Int. Heart J.

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SummaryThe aim of this study was to evaluate the capacity of the SYNTAX Score-II (SS-II) to predict long-term mortality in patients undergoing left main percutaneous coronary intervention (LM-PCI) treated with second-generation drug-eluting stents (DES).Data from 487 consecutive patients with de novo left main coronary artery disease undergoing PCI were retrospectively studied. The patients were divided into tertiles according to the SS-II: low SS-II tertile (SS-II ≤ 22), intermediate SS-II tertile (SS-II of 23 to 30), and high SS-II tertile (SS-II ≥ 30). The survival curves were estimated by the KaplanMeier method. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the possible associations between the SS-II and the rates of long-term mortality. The predictive ability of the SS-II for mortality was assessed and compared with the SYNTAX score (SS) alone by an area under the receiver operator curve (AUC).The overall SS-II was 27.3 ± 9.1. At a mean follow-up of 5.1 years, the long-term mortality was 6.0%. The rates of mortality were 2.4%, 3.4%, and 11.6%, respectively (P < 0.0001) in the low, intermediate, and high SS-II tertiles. The cardiac mortality rates were 1.8%, 1.4%, and 8.1%, respectively (P = 0.002) among patients in the 3 groups. By multivariate analysis, SS-II was an independent predictor of the long-term mortality (hazard ratio: 1.56, 95% confidence interval: 1.05 to 2.32; P = 0.03). The AUC demonstrated a substantially higher predictive accuracy of the SS-II for mortality compared with the SS alone (AUC was 0.689 and 0.596, respectively).In patients with LM-PCI treated with a second-generation DES, the SS-II is an independent predictor of long-term mortality and demonstrates a superior predictability compared with the SS alone. (Int Heart J 2017; 58: 344-350) Key words: Left main coronary artery disease, Predict T he SYNTAX score II (SS-II) was recently developed by applying a Cox proportional hazards model to the results of the SYNTAX trial data. The SS-II incorporates a combination of two anatomical (anatomical SS and left main coronary artery disease) and 6 clinical variables (age, sex, left ventricular ejection fraction, creatinine clearance, chronic obstructive pulmonary disease, and peripheral vascular disease).1) The SS-II has been shown to provide reliable predictions of 4-year mortality for complex coronary artery disease (CAD), being internally validated in the landmark, all-comers, randomized SYNTAX trial 1,2) and externally applied in two real world registries.3,4) Therefore, the SS-II provides an impartial, evidence-based assessment of the decision-making process for clinicians weighing anatomical and clinical factors to establish the optimum revascularization technique for individual patients with complex CAD. However, all previous studies [1][2][3][4][5] about the validation of the SS-II have enrolled patients totally or mostly treated with a first-generation DES and some even used a small number of bare metal stents. At present, secon...

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Section: Discussionmentioning

confidence: 99%

SYNTAX Score-II Predicts Long-Term Mortality in Patients Who Underwent Left Main Percutaneous Coronary Intervention Treated With Second-Generation Drug-Eluting Stents

Zhao

et al. 2017

Int. Heart J.

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“…Oleh sebab itu, terdapat Syntax II yang juga memperhitungkan faktor usia, penyakit paru kronik, klirens kreatinin dan left ventricle ejection fraction yang berkaitan dengan keadaan gagal jantung. 15 Pada penelitian ini, skor Syntax>33 pada kelompok BPK IKP dan medikamentosa masing-masing secara berturut-turut yaitu 100%, 59,3% dan 58,3%. Studi Syntax mengatakan bahwa BPK masih merupakan pilihan pada penderita PJK 3PD dengan skor Syntax >33, baik DM maupun non-DM, 7 Sementara itu, BARI trial mendapati bahwa angka keberhasilan jangka panjang BPK lebih baik dibanding IKP pada PJK 3PD dengan DM.…”

Section: Karakteristikunclassified

Kesintasan Lima Tahun Pasien Penyakit Jantung Koroner Tiga Pembuluh Darah dengan Diabetes Melitus yang Menjalani Bedah Pintas Koroner, Intervensi Koroner Perkutan atau Medikamentosa di Rumah Sakit dr. Cipto Mangunkusumo

Setiawan¹,

Panggabean²,

Yamin³

et al. 2017

JPDI

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ABSTRAKPendahuluan. Hasil revaskularisasi pada pasien diabetes melitus (DM) dengan penyakit jantung koroner 3 pembuluh darah (PJK 3PD) dengan bedah pintas koroner (BPK) lebih baik dibandingkan intervensi koroner perkutan (IKP) atau medikamentosa. BPK tidak selalu menjadi prosedur yang dikerjakan meskipun sudah direkomendasikan sesuai Skor Syntax. Selain itu, tidak semua pasien bersedia menjalani BPK atau IKP. Perlu diketahui apakah pilihan revaskularisasi tersebut mempengaruhi kesintasan 5 tahun.Metode. Penelitian ini merupakan studi kohort retrospektif dengan pendekatan analisis kesintasan untuk meneliti kesintasan 5 tahun pasien PJK 3PD DM yang menjalani tindakan BPK, IKP atau medikamentosa. Penelitian dilakukan dengan menggunakan data sekunder 126 pasien PJK 3PD DM yang menjalani BPK, IKP, maupun medikamentosa di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta pada tahun 2006-2007 dan diikuti sampai dengan tahun 2011-2012 dengan dilihat adakah kejadian meninggal.Hasil. Kesintasan terbaik diketahui yaitu pada kelompok BPK (93,5%). Proporsi kematian terbesar terdapat pada kelompok medikamentosa (36,1%). Selain itu, hasil analisis menunjukkan bahwa kelompok IKP memiliki kesintasan yang lebih baik dibanding medikamentosa (69,5% vs 63,9%). Meskipun tidak bermakna secara statistik, namun pada kelompok IKP proporsi keluhan yang ditemukan setelah tindakan lebih sedikit dibanding kelompok medikamentosa (52% vs 38%). Skor Syntax yang berperan menilai kompleksitas stenosis diketahui turut menentukan kesintasan (p= 0,039).Simpulan. Kesintasan 5 tahun pasien PJK 3PD dengan DM yang paling baik didapatkan pada kelompok yang menjalani BPK. Kesintasan 5 tahun pasien PJK 3PD dengan DM yang menjalani IKP lebih baik dibandingkan medikamentosa, namun secara statistik tidak bermakna. Faktor yang berpengaruh pada kesintasan 5 tahun pasien PJK 3PD adalah kompleksitas stenosis yang dilihat dengan menggunakan skor Syntax. Kata kunci: DM, kesintasan 5 tahun, PJK 3PD

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“…The anatomical SYNTAX score, with low (<23), intermediate (23)(24)(25)(26)(27)(28)(29)(30)(31)(32) or high (>32) categories, 8,12 became a sentinel tool in the SYNTAX trial and pioneered the now-popular "Heart Team" approach, in which a cardiac surgeon and interventional cardiologist determine the optimal revascularization modality for patients with 3VD/ULMCA disease. It combines the importance of diseased vessel segment weighting (Leaman score), adverse lesion characteristics (American College of Cardiology/American Heart Association lesion classification, and total occlusion characteristics from the European TOTAL Surveillance Study) and the Medina classification system for bifurcation lesions.…”

Section: After Syntaxmentioning

confidence: 99%

“…age/ejection fraction + 1 point for every 10 ml/ min reduction in creatinine clearance below 60 ml/ min/1.73 m 2 (up to a maximum of 6 points)]), the Global Risk score (a combination of the SYNTAX score and EuroSCORE) and the EuroHeart score. [18][19][20][21][22][23][24][25][26][27] The latest addition to this risk stratification mélange is the SYNTAX score II, which includes a nomogram for bedside application to obtain long-term mortality predictions for individual patients considering CABG or PCI. 28 This score, which was externally validated in the multinational DELTA (n=2,891) and Credo-KYOTO (n=3,896) registries, 8,29 consists of two anatomical (SYNTAX score and ULMCA disease) and six clinical (age, creatinine clearance, left ventricular ejection fraction, sex, chronic obstructive pulmonary disease and peripheral vascular disease) variables.…”

Section: After Syntaxmentioning

confidence: 99%

A Tale of Two Techniques: Demystifying the Myth

Jan¹

2015

Journal of Patient-Centered Research and Reviews

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Combined anatomical and clinical factors for the long-term risk stratification of patients undergoing percutaneous coronary intervention: the Logistic Clinical SYNTAX score

Abstract: The Logistic Clinical SXscore substantially enhances the prediction of 1-year mortality after PCI compared with the SXscore, and allows for an accurate personalized assessment of patient risk.

Cited by 148 publications

References 54 publications

SYNTAX Score-II Predicts Long-Term Mortality in Patients Who Underwent Left Main Percutaneous Coronary Intervention Treated With Second-Generation Drug-Eluting Stents

SYNTAX Score-II Predicts Long-Term Mortality in Patients Who Underwent Left Main Percutaneous Coronary Intervention Treated With Second-Generation Drug-Eluting Stents

Kesintasan Lima Tahun Pasien Penyakit Jantung Koroner Tiga Pembuluh Darah dengan Diabetes Melitus yang Menjalani Bedah Pintas Koroner, Intervensi Koroner Perkutan atau Medikamentosa di Rumah Sakit dr. Cipto Mangunkusumo

A Tale of Two Techniques: Demystifying the Myth

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