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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

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

In: European Heart Journal, 2012, vol. 33, no. 24, p. 3098-3104

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    Title
    • Combined anatomical and clinical factors for the long-term risk stratification of patients undergoing percutaneous coronary intervention: the Logistic Clinical SYNTAX score
    Author
    • Farooq, Vasim. Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
    • Vergouwe, Yvonne. Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
    • Räber, Lorenz. Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
    • Vranckx, Pascal. Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
    • Garcia-Garcia, Hector. Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
    • Diletti, Roberto. Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
    • Kappetein, Arie Pieter. Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands
    • Morel, Marie Angèle. Cardialysis BV, Rotterdam, The Netherlands
    • de Vries, Ton. Cardialysis BV, Rotterdam, The Netherlands
    • Swart, Michael. Cardialysis BV, Rotterdam, The Netherlands
    • Valgimigli, Marco. Department of Interventional Cardiology, Cardiovascular Institute, University of Ferrara, Ferrara, Italy
    • Dawkins, Keith D.. Boston Scientific Corporation, Natick, MA, USA
    • Windecker, Stephan. Cardiology Department, Bern University Hospital, Bern, Switzerland
    • Steyerberg, Ewout W.. Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
    • Serruys, Patrick W.. Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
    Document Type
    • Postprint
    Classification
    • Health
    OAI-PMH Identifier
    • oai:doc.rero.ch:297976
    Summary
    Background The SYNTAX score (SXscore), an anatomical-based scoring tool reflecting the complexity of coronary anatomy, has established itself as an important long-term prognostic factor in patients undergoing percutaneous coronary intervention (PCI). The incorporation of clinical factors may further augment the utility of the SXscore to longer-term risk stratify the individual patient for clinical outcomes. Methods and results Patient-level merged data from >6000 patients in seven contemporary coronary stent trials was used to develop a logistic regression model—the Logistic Clinical SXscore—to predict 1-year risk for all-cause death and major adverse cardiac events (MACE). A core model (composed of the SXscore, age, creatinine clearance, and left ventricular ejection fraction) and an extended model [incorporating the core model and six additional (best performing) clinical variables] were developed and validated in a cross-validation procedure. The core model demonstrated a substantial improvement in predictive ability for 1-year all-cause death compared with the SXscore in isolation [area under the receiver operator curve (AUC): core model: 0.753, SXscore: 0.660]. A minor incremental benefit of the extended model was shown (AUC: 0.791). Consequently the core model alone was retained in the final the Logistic Clinical SXscore model. Validation plots confirmed the model predictions to be well calibrated. For 1-year MACE, the addition of clinical variables did not improve the predictive ability of the SXscore, secondary to the SXscore being the predominant determinant of all-cause revascularization. Conclusion 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