Comparison of clinical and angiographic prognostic risk scores in patients with acute coronary syndromes: Analysis from the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial

Tullio Palmerini, Adriano Caixeta, Philippe Genereux, Ecaterina Cristea, Alexandra Lansky, Roxana Mehran, George Dangas, Dana Lazar, Rachel Sanchez, Martin Fahy, Ke Xu, Gregg W. Stone

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Several prognostic risk scores have been developed for patients with coronary artery disease, but their comparative use in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) undergoing percutaneous coronary intervention (PCI) has not been examined. We therefore investigated the accuracy of the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score, Clinical Synergy Between PCI With Taxus and Cardiac Surgery score (CSS), New Risk Stratification (NERS) score (NERS), Age, Creatinine, Ejection Fraction (ACEF) score, Global Registry for Acute Coronary Events (GRACE) score, and Thrombolysis in Myocardial Infarction (TIMI) score for risk assessment of 1-year mortality, cardiac mortality, myocardial infarction, target vessel revascularization, and stent thrombosis in patients with NSTEACS undergoing PCI. Methods: The 6 scores were determined in 2,094 patients with NSTEACS treated with PCI enrolled in the angiographic substudy of the ACUITY trial. The prognostic accuracy of the 6 scores was assessed using the c statistic for discrimination and the Hosmer-Lemeshow test for calibration. The index of separation and net reclassification improvement (NRI) were also determined. Results: Scores incorporating clinical and angiographic variables (CSS and NERS) showed the best tradeoff between discrimination and calibration for most end points, with the best discrimination for all end points and good calibration for most of them. The CSS had the best index of separation for most ischemic endpoints and displayed an NRI for cardiac death and myocardial infarction (MI) compared to the other scores, whereas NERS displayed an NRI for all-cause death and target vessel revascularization. The 3 scores-CSS, NERS, and SYNTAX-were the only scores to have both good discrimination and calibration for cardiac mortality. Conclusions: In patients with NSTEACS undergoing PCI, risk scores incorporating clinical and angiographic variables had the highest predictive accuracy for a broad spectrum of ischemic end points.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume163
Issue number3
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

Fingerprint

Triage
Acute Coronary Syndrome
Catheterization
Percutaneous Coronary Intervention
Thoracic Surgery
Calibration
Taxus
Myocardial Infarction
Mortality
Stents
Registries
Coronary Artery Disease
Cause of Death
Creatinine
Thrombosis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Palmerini, Tullio ; Caixeta, Adriano ; Genereux, Philippe ; Cristea, Ecaterina ; Lansky, Alexandra ; Mehran, Roxana ; Dangas, George ; Lazar, Dana ; Sanchez, Rachel ; Fahy, Martin ; Xu, Ke ; Stone, Gregg W. / Comparison of clinical and angiographic prognostic risk scores in patients with acute coronary syndromes : Analysis from the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial. In: American Heart Journal. 2012 ; Vol. 163, No. 3.
@article{bc462e9bd68b40dfa9b7aa487c21aa58,
title = "Comparison of clinical and angiographic prognostic risk scores in patients with acute coronary syndromes: Analysis from the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial",
abstract = "Background: Several prognostic risk scores have been developed for patients with coronary artery disease, but their comparative use in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) undergoing percutaneous coronary intervention (PCI) has not been examined. We therefore investigated the accuracy of the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score, Clinical Synergy Between PCI With Taxus and Cardiac Surgery score (CSS), New Risk Stratification (NERS) score (NERS), Age, Creatinine, Ejection Fraction (ACEF) score, Global Registry for Acute Coronary Events (GRACE) score, and Thrombolysis in Myocardial Infarction (TIMI) score for risk assessment of 1-year mortality, cardiac mortality, myocardial infarction, target vessel revascularization, and stent thrombosis in patients with NSTEACS undergoing PCI. Methods: The 6 scores were determined in 2,094 patients with NSTEACS treated with PCI enrolled in the angiographic substudy of the ACUITY trial. The prognostic accuracy of the 6 scores was assessed using the c statistic for discrimination and the Hosmer-Lemeshow test for calibration. The index of separation and net reclassification improvement (NRI) were also determined. Results: Scores incorporating clinical and angiographic variables (CSS and NERS) showed the best tradeoff between discrimination and calibration for most end points, with the best discrimination for all end points and good calibration for most of them. The CSS had the best index of separation for most ischemic endpoints and displayed an NRI for cardiac death and myocardial infarction (MI) compared to the other scores, whereas NERS displayed an NRI for all-cause death and target vessel revascularization. The 3 scores-CSS, NERS, and SYNTAX-were the only scores to have both good discrimination and calibration for cardiac mortality. Conclusions: In patients with NSTEACS undergoing PCI, risk scores incorporating clinical and angiographic variables had the highest predictive accuracy for a broad spectrum of ischemic end points.",
author = "Tullio Palmerini and Adriano Caixeta and Philippe Genereux and Ecaterina Cristea and Alexandra Lansky and Roxana Mehran and George Dangas and Dana Lazar and Rachel Sanchez and Martin Fahy and Ke Xu and Stone, {Gregg W.}",
year = "2012",
month = "1",
day = "1",
doi = "10.1016/j.ahj.2011.11.010",
language = "English (US)",
volume = "163",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "3",

}

Comparison of clinical and angiographic prognostic risk scores in patients with acute coronary syndromes : Analysis from the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial. / Palmerini, Tullio; Caixeta, Adriano; Genereux, Philippe; Cristea, Ecaterina; Lansky, Alexandra; Mehran, Roxana; Dangas, George; Lazar, Dana; Sanchez, Rachel; Fahy, Martin; Xu, Ke; Stone, Gregg W.

In: American Heart Journal, Vol. 163, No. 3, 01.01.2012.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of clinical and angiographic prognostic risk scores in patients with acute coronary syndromes

T2 - Analysis from the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial

AU - Palmerini, Tullio

AU - Caixeta, Adriano

AU - Genereux, Philippe

AU - Cristea, Ecaterina

AU - Lansky, Alexandra

AU - Mehran, Roxana

AU - Dangas, George

AU - Lazar, Dana

AU - Sanchez, Rachel

AU - Fahy, Martin

AU - Xu, Ke

AU - Stone, Gregg W.

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Background: Several prognostic risk scores have been developed for patients with coronary artery disease, but their comparative use in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) undergoing percutaneous coronary intervention (PCI) has not been examined. We therefore investigated the accuracy of the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score, Clinical Synergy Between PCI With Taxus and Cardiac Surgery score (CSS), New Risk Stratification (NERS) score (NERS), Age, Creatinine, Ejection Fraction (ACEF) score, Global Registry for Acute Coronary Events (GRACE) score, and Thrombolysis in Myocardial Infarction (TIMI) score for risk assessment of 1-year mortality, cardiac mortality, myocardial infarction, target vessel revascularization, and stent thrombosis in patients with NSTEACS undergoing PCI. Methods: The 6 scores were determined in 2,094 patients with NSTEACS treated with PCI enrolled in the angiographic substudy of the ACUITY trial. The prognostic accuracy of the 6 scores was assessed using the c statistic for discrimination and the Hosmer-Lemeshow test for calibration. The index of separation and net reclassification improvement (NRI) were also determined. Results: Scores incorporating clinical and angiographic variables (CSS and NERS) showed the best tradeoff between discrimination and calibration for most end points, with the best discrimination for all end points and good calibration for most of them. The CSS had the best index of separation for most ischemic endpoints and displayed an NRI for cardiac death and myocardial infarction (MI) compared to the other scores, whereas NERS displayed an NRI for all-cause death and target vessel revascularization. The 3 scores-CSS, NERS, and SYNTAX-were the only scores to have both good discrimination and calibration for cardiac mortality. Conclusions: In patients with NSTEACS undergoing PCI, risk scores incorporating clinical and angiographic variables had the highest predictive accuracy for a broad spectrum of ischemic end points.

AB - Background: Several prognostic risk scores have been developed for patients with coronary artery disease, but their comparative use in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) undergoing percutaneous coronary intervention (PCI) has not been examined. We therefore investigated the accuracy of the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score, Clinical Synergy Between PCI With Taxus and Cardiac Surgery score (CSS), New Risk Stratification (NERS) score (NERS), Age, Creatinine, Ejection Fraction (ACEF) score, Global Registry for Acute Coronary Events (GRACE) score, and Thrombolysis in Myocardial Infarction (TIMI) score for risk assessment of 1-year mortality, cardiac mortality, myocardial infarction, target vessel revascularization, and stent thrombosis in patients with NSTEACS undergoing PCI. Methods: The 6 scores were determined in 2,094 patients with NSTEACS treated with PCI enrolled in the angiographic substudy of the ACUITY trial. The prognostic accuracy of the 6 scores was assessed using the c statistic for discrimination and the Hosmer-Lemeshow test for calibration. The index of separation and net reclassification improvement (NRI) were also determined. Results: Scores incorporating clinical and angiographic variables (CSS and NERS) showed the best tradeoff between discrimination and calibration for most end points, with the best discrimination for all end points and good calibration for most of them. The CSS had the best index of separation for most ischemic endpoints and displayed an NRI for cardiac death and myocardial infarction (MI) compared to the other scores, whereas NERS displayed an NRI for all-cause death and target vessel revascularization. The 3 scores-CSS, NERS, and SYNTAX-were the only scores to have both good discrimination and calibration for cardiac mortality. Conclusions: In patients with NSTEACS undergoing PCI, risk scores incorporating clinical and angiographic variables had the highest predictive accuracy for a broad spectrum of ischemic end points.

UR - http://www.scopus.com/inward/record.url?scp=84858325063&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84858325063&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2011.11.010

DO - 10.1016/j.ahj.2011.11.010

M3 - Article

C2 - 22424008

AN - SCOPUS:84858325063

VL - 163

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 3

ER -