Prediction of 1-year mortality in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Validation of the logistic clinical syntax (synergy between percutaneous coronary interventions with taxus and cardiac surgery) score

Vasim Farooq, Yvonne Vergouwe, Philippe Généreux, Christos V. Bourantas, Tullio Palmerini, Adriano Caixeta, Hector M. Garcìa-Garcìa, Roberto Diletti, Marie Angèle Morel, Thomas C. McAndrew, Arie Pieter Kappetein, Marco Valgimigli, Stephan Windecker, Keith D. Dawkins, Ewout W. Steyerberg, Patrick W. Serruys, Gregg W. Stone

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35 Citations (Scopus)

Abstract

Objectives This study sought to validate the Logistic Clinical SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score in patients with non-ST-segment elevation acute coronary syndromes (ACS), in order to further legitimize its clinical application. Background The Logistic Clinical SYNTAX score allows for an individualized prediction of 1-year mortality in patients undergoing contemporary percutaneous coronary intervention. It is composed of a "Core" Model (anatomical SYNTAX score, age, creatinine clearance, and left ventricular ejection fraction), and "Extended" Model (composed of an additional 6 clinical variables), and has previously been cross validated in 7 contemporary stent trials (>6,000 patients). Methods One-year all-cause death was analyzed in 2,627 patients undergoing percutaneous coronary intervention from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. Mortality predictions from the Core and Extended Models were studied with respect to discrimination, that is, separation of those with and without 1-year all-cause death (assessed by the concordance [C] statistic), and calibration, that is, agreement between observed and predicted outcomes (assessed with validation plots). Decision curve analyses, which weight the harms (false positives) against benefits (true positives) of using a risk score to make mortality predictions, were undertaken to assess clinical usefulness. Results In the ACUITY trial, the median SYNTAX score was 9.0 (interquartile range 5.0 to 16.0); approximately 40% of patients had 3-vessel disease, 29% diabetes, and 85% underwent drug-eluting stent implantation. Validation plots confirmed agreement between observed and predicted mortality. The Core and Extended Models demonstrated substantial improvements in the discriminative ability for 1-year all-cause death compared with the anatomical SYNTAX score in isolation (C-statistics: SYNTAX score: 0.64, 95% confidence interval [CI]: 0.56 to 0.71; Core Model: 0.74, 95% CI: 0.66 to 0.79; Extended Model: 0.77, 95% CI: 0.70 to 0.83). Decision curve analyses confirmed the increasing ability to correctly identify patients who would die at 1 year with the Extended Model versus the Core Model versus the anatomical SYNTAX score, over a wide range of thresholds for mortality risk predictions. Conclusions Compared to the anatomical SYNTAX score alone, the Core and Extended Models of the Logistic Clinical SYNTAX score more accurately predicted individual 1-year mortality in patients presenting with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention. These findings support the clinical application of the Logistic Clinical SYNTAX score.

Original languageEnglish (US)
Pages (from-to)737-745
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume6
Issue number7
DOIs
StatePublished - Jul 1 2013

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Taxus
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Thoracic Surgery
Mortality
Anatomic Models
Cause of Death
Decision Support Techniques
Triage
Confidence Intervals
Catheterization
Drug-Eluting Stents
Stroke Volume
Calibration
Stents
Creatinine
Logistic Models
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Farooq, Vasim ; Vergouwe, Yvonne ; Généreux, Philippe ; Bourantas, Christos V. ; Palmerini, Tullio ; Caixeta, Adriano ; Garcìa-Garcìa, Hector M. ; Diletti, Roberto ; Morel, Marie Angèle ; McAndrew, Thomas C. ; Kappetein, Arie Pieter ; Valgimigli, Marco ; Windecker, Stephan ; Dawkins, Keith D. ; Steyerberg, Ewout W. ; Serruys, Patrick W. ; Stone, Gregg W. / Prediction of 1-year mortality in patients with acute coronary syndromes undergoing percutaneous coronary intervention : Validation of the logistic clinical syntax (synergy between percutaneous coronary interventions with taxus and cardiac surgery) score. In: JACC: Cardiovascular Interventions. 2013 ; Vol. 6, No. 7. pp. 737-745.
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title = "Prediction of 1-year mortality in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Validation of the logistic clinical syntax (synergy between percutaneous coronary interventions with taxus and cardiac surgery) score",
abstract = "Objectives This study sought to validate the Logistic Clinical SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score in patients with non-ST-segment elevation acute coronary syndromes (ACS), in order to further legitimize its clinical application. Background The Logistic Clinical SYNTAX score allows for an individualized prediction of 1-year mortality in patients undergoing contemporary percutaneous coronary intervention. It is composed of a {"}Core{"} Model (anatomical SYNTAX score, age, creatinine clearance, and left ventricular ejection fraction), and {"}Extended{"} Model (composed of an additional 6 clinical variables), and has previously been cross validated in 7 contemporary stent trials (>6,000 patients). Methods One-year all-cause death was analyzed in 2,627 patients undergoing percutaneous coronary intervention from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. Mortality predictions from the Core and Extended Models were studied with respect to discrimination, that is, separation of those with and without 1-year all-cause death (assessed by the concordance [C] statistic), and calibration, that is, agreement between observed and predicted outcomes (assessed with validation plots). Decision curve analyses, which weight the harms (false positives) against benefits (true positives) of using a risk score to make mortality predictions, were undertaken to assess clinical usefulness. Results In the ACUITY trial, the median SYNTAX score was 9.0 (interquartile range 5.0 to 16.0); approximately 40{\%} of patients had 3-vessel disease, 29{\%} diabetes, and 85{\%} underwent drug-eluting stent implantation. Validation plots confirmed agreement between observed and predicted mortality. The Core and Extended Models demonstrated substantial improvements in the discriminative ability for 1-year all-cause death compared with the anatomical SYNTAX score in isolation (C-statistics: SYNTAX score: 0.64, 95{\%} confidence interval [CI]: 0.56 to 0.71; Core Model: 0.74, 95{\%} CI: 0.66 to 0.79; Extended Model: 0.77, 95{\%} CI: 0.70 to 0.83). Decision curve analyses confirmed the increasing ability to correctly identify patients who would die at 1 year with the Extended Model versus the Core Model versus the anatomical SYNTAX score, over a wide range of thresholds for mortality risk predictions. Conclusions Compared to the anatomical SYNTAX score alone, the Core and Extended Models of the Logistic Clinical SYNTAX score more accurately predicted individual 1-year mortality in patients presenting with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention. These findings support the clinical application of the Logistic Clinical SYNTAX score.",
author = "Vasim Farooq and Yvonne Vergouwe and Philippe G{\'e}n{\'e}reux and Bourantas, {Christos V.} and Tullio Palmerini and Adriano Caixeta and Garc{\`i}a-Garc{\`i}a, {Hector M.} and Roberto Diletti and Morel, {Marie Ang{\`e}le} and McAndrew, {Thomas C.} and Kappetein, {Arie Pieter} and Marco Valgimigli and Stephan Windecker and Dawkins, {Keith D.} and Steyerberg, {Ewout W.} and Serruys, {Patrick W.} and Stone, {Gregg W.}",
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Farooq, V, Vergouwe, Y, Généreux, P, Bourantas, CV, Palmerini, T, Caixeta, A, Garcìa-Garcìa, HM, Diletti, R, Morel, MA, McAndrew, TC, Kappetein, AP, Valgimigli, M, Windecker, S, Dawkins, KD, Steyerberg, EW, Serruys, PW & Stone, GW 2013, 'Prediction of 1-year mortality in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Validation of the logistic clinical syntax (synergy between percutaneous coronary interventions with taxus and cardiac surgery) score', JACC: Cardiovascular Interventions, vol. 6, no. 7, pp. 737-745. https://doi.org/10.1016/j.jcin.2013.04.004

Prediction of 1-year mortality in patients with acute coronary syndromes undergoing percutaneous coronary intervention : Validation of the logistic clinical syntax (synergy between percutaneous coronary interventions with taxus and cardiac surgery) score. / Farooq, Vasim; Vergouwe, Yvonne; Généreux, Philippe; Bourantas, Christos V.; Palmerini, Tullio; Caixeta, Adriano; Garcìa-Garcìa, Hector M.; Diletti, Roberto; Morel, Marie Angèle; McAndrew, Thomas C.; Kappetein, Arie Pieter; Valgimigli, Marco; Windecker, Stephan; Dawkins, Keith D.; Steyerberg, Ewout W.; Serruys, Patrick W.; Stone, Gregg W.

In: JACC: Cardiovascular Interventions, Vol. 6, No. 7, 01.07.2013, p. 737-745.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prediction of 1-year mortality in patients with acute coronary syndromes undergoing percutaneous coronary intervention

T2 - Validation of the logistic clinical syntax (synergy between percutaneous coronary interventions with taxus and cardiac surgery) score

AU - Farooq, Vasim

AU - Vergouwe, Yvonne

AU - Généreux, Philippe

AU - Bourantas, Christos V.

AU - Palmerini, Tullio

AU - Caixeta, Adriano

AU - Garcìa-Garcìa, Hector M.

AU - Diletti, Roberto

AU - Morel, Marie Angèle

AU - McAndrew, Thomas C.

AU - Kappetein, Arie Pieter

AU - Valgimigli, Marco

AU - Windecker, Stephan

AU - Dawkins, Keith D.

AU - Steyerberg, Ewout W.

AU - Serruys, Patrick W.

AU - Stone, Gregg W.

PY - 2013/7/1

Y1 - 2013/7/1

N2 - Objectives This study sought to validate the Logistic Clinical SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score in patients with non-ST-segment elevation acute coronary syndromes (ACS), in order to further legitimize its clinical application. Background The Logistic Clinical SYNTAX score allows for an individualized prediction of 1-year mortality in patients undergoing contemporary percutaneous coronary intervention. It is composed of a "Core" Model (anatomical SYNTAX score, age, creatinine clearance, and left ventricular ejection fraction), and "Extended" Model (composed of an additional 6 clinical variables), and has previously been cross validated in 7 contemporary stent trials (>6,000 patients). Methods One-year all-cause death was analyzed in 2,627 patients undergoing percutaneous coronary intervention from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. Mortality predictions from the Core and Extended Models were studied with respect to discrimination, that is, separation of those with and without 1-year all-cause death (assessed by the concordance [C] statistic), and calibration, that is, agreement between observed and predicted outcomes (assessed with validation plots). Decision curve analyses, which weight the harms (false positives) against benefits (true positives) of using a risk score to make mortality predictions, were undertaken to assess clinical usefulness. Results In the ACUITY trial, the median SYNTAX score was 9.0 (interquartile range 5.0 to 16.0); approximately 40% of patients had 3-vessel disease, 29% diabetes, and 85% underwent drug-eluting stent implantation. Validation plots confirmed agreement between observed and predicted mortality. The Core and Extended Models demonstrated substantial improvements in the discriminative ability for 1-year all-cause death compared with the anatomical SYNTAX score in isolation (C-statistics: SYNTAX score: 0.64, 95% confidence interval [CI]: 0.56 to 0.71; Core Model: 0.74, 95% CI: 0.66 to 0.79; Extended Model: 0.77, 95% CI: 0.70 to 0.83). Decision curve analyses confirmed the increasing ability to correctly identify patients who would die at 1 year with the Extended Model versus the Core Model versus the anatomical SYNTAX score, over a wide range of thresholds for mortality risk predictions. Conclusions Compared to the anatomical SYNTAX score alone, the Core and Extended Models of the Logistic Clinical SYNTAX score more accurately predicted individual 1-year mortality in patients presenting with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention. These findings support the clinical application of the Logistic Clinical SYNTAX score.

AB - Objectives This study sought to validate the Logistic Clinical SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score in patients with non-ST-segment elevation acute coronary syndromes (ACS), in order to further legitimize its clinical application. Background The Logistic Clinical SYNTAX score allows for an individualized prediction of 1-year mortality in patients undergoing contemporary percutaneous coronary intervention. It is composed of a "Core" Model (anatomical SYNTAX score, age, creatinine clearance, and left ventricular ejection fraction), and "Extended" Model (composed of an additional 6 clinical variables), and has previously been cross validated in 7 contemporary stent trials (>6,000 patients). Methods One-year all-cause death was analyzed in 2,627 patients undergoing percutaneous coronary intervention from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. Mortality predictions from the Core and Extended Models were studied with respect to discrimination, that is, separation of those with and without 1-year all-cause death (assessed by the concordance [C] statistic), and calibration, that is, agreement between observed and predicted outcomes (assessed with validation plots). Decision curve analyses, which weight the harms (false positives) against benefits (true positives) of using a risk score to make mortality predictions, were undertaken to assess clinical usefulness. Results In the ACUITY trial, the median SYNTAX score was 9.0 (interquartile range 5.0 to 16.0); approximately 40% of patients had 3-vessel disease, 29% diabetes, and 85% underwent drug-eluting stent implantation. Validation plots confirmed agreement between observed and predicted mortality. The Core and Extended Models demonstrated substantial improvements in the discriminative ability for 1-year all-cause death compared with the anatomical SYNTAX score in isolation (C-statistics: SYNTAX score: 0.64, 95% confidence interval [CI]: 0.56 to 0.71; Core Model: 0.74, 95% CI: 0.66 to 0.79; Extended Model: 0.77, 95% CI: 0.70 to 0.83). Decision curve analyses confirmed the increasing ability to correctly identify patients who would die at 1 year with the Extended Model versus the Core Model versus the anatomical SYNTAX score, over a wide range of thresholds for mortality risk predictions. Conclusions Compared to the anatomical SYNTAX score alone, the Core and Extended Models of the Logistic Clinical SYNTAX score more accurately predicted individual 1-year mortality in patients presenting with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention. These findings support the clinical application of the Logistic Clinical SYNTAX score.

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