Abstract 12763: The Clinical SYNTAX Score Has an Additive Predictive Value in High Risk Patients
Introduction: The SYNTAX score (SS) has been used as an angiographic grading tool to determine the complexity of coronary diseases, and was verified to predict outcomes after revascularization. However, the SS neglected clinical factors, which brought up an alternative, the clinical SS (cSS). Many studies compared the predictivity of SS and cSS, yet due to inconsistent results, the superiority of SS or cSS still remains as an issue. In this study, we investigated the predictivity of SS and cSS in various clinical situations.
Hypothesis: cSS will be superior to SS in high risk patients.
Methods: Patients were enrolled from the Efficacy of Xience/Promus versus Cypher in rEducing Late Loss after stENTing (EXCELLENT) registry. SS and cSS were checked at an independent angiographic core lab. The primary clinical outcome was 3-year patient-oriented composite endpoint (POCE; a composite of all cause death, any myocardial infarction, and any revascularization).
Results: We calculated SS and cSS for the 5,102 patients from the EXCELLENT registry. When patients had a risk factor such as old age, hypertension, diabetes, current smoking, low ejection fraction, renal insufficiency and no use of statin, the cSS was superior to SS, whereas in patients without risk factors, there was no additive value of the cSS. Patients were divided into 3 groups, according to the number of risk factors present. As a result, 37.1% were in the low risk group (0-2 risk factors), 30.8% were in the intermediate risk group (3 risk factors) and 27.1% were in the high risk group (4-7 risk factors). POCE increased according to risk group; 10.4%, 13.4%, 18.9%, p<0.001 in the low, intermediate, high risk group respectively. Also by receiver operating characteristic analysis, predictivity of SS was superior to cSS in the low risk group whereas in the intermediate and high risk group, cSS was superior (low risk group: 0.631 vs. 0.637, intermediate risk group: 0.598 vs. 0.632, high risk group: 0.600 vs. 0.644, for SS and cSS).
Conclusions: SS is superior to cSS in low risk patients, whereas in high risk patients, the cSS has better predictivity. The presence of classical risk factors should be considered when using the SS as a predictive tool after revascularization.
Author Disclosures: J. Kang: None. K. Park: None. S. Kang: None. H. Lee: None. H. Kang: None. B. Koo: None. I. Chae: None. T. Youn: None. B. Oh: None. Y. Park: None. H. Kim: None.
- © 2014 by American Heart Association, Inc.