Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention

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

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

Research output: Contribution to journalArticle

175 Citations (Scopus)

Abstract

Objectives: We sought to investigate the predictive value of the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score (SS) for risk assessment of 1-year clinical outcomes in patients with nonST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention (PCI). Background: In the SYNTAX trial, the SS was effective in risk-stratifying patients with left main and triple-vessel coronary disease, the majority of whom had stable ischemic heart disease. Methods: The SS was determined in 2,627 patients with nonST-segment elevation acute coronary syndromes undergoing PCI in the angiographic substudy of the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. Patients were stratified according to tertiles of the SS: <7 (n = 854), <7 and <13 (n = 825), and <13 (n = 948). Results: Among patients in the first, second, and third SS tertiles, the 1-year rates of mortality were 1.5%, 1.6%, and 4.0%, respectively (p = 0.0005); the cardiac mortality rates were 0.2%, 0.9%, and 2.7%, respectively (p < 0.0001); the myocardial infarction (MI) rates were 6.3%, 8.3%, and 12.9%, respectively (p < 0.0001); and the target vessel revascularization (TVR) rates were 7.4%, 7.0%, and 9.8%, respectively (p = 0.02). By multivariable analysis, the SS was an independent predictor of 1-year death (hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.01 to 1.07; p = 0.005), cardiac death (HR: 1.06, 95% CI: 1.03 to 1.09; p = 0.0002), MI (HR: 1.03, 95% CI: 1.02 to 1.05; p < 0.0001), and TVR (HR: 1.03, 95% CI: 1.02 to 1.05; p < 0.0001). The SS affected death, cardiac death, and MI both within the first 30 days after PCI and between 30 days and 1 year, whereas it affected TVR primarily within the first 30 days. The predictive value of an increased SS was consistent among multiple pre-specified subgroups. Conclusions: In patients with nonST-segment elevation acute coronary syndromes undergoing PCI, the SS is an independent predictor of the 1-year rates of death, cardiac death, MI, and TVR. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158)

Original languageEnglish (US)
Pages (from-to)2389-2397
Number of pages9
JournalJournal of the American College of Cardiology
Volume57
Issue number24
DOIs
StatePublished - Jun 14 2011
Externally publishedYes

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Triage
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Catheterization
Myocardial Infarction
Confidence Intervals
Mortality
Taxus
Thoracic Surgery
Myocardial Ischemia
Coronary Disease
Heparin

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Palmerini, Tullio ; Genereux, Philippe ; Caixeta, Adriano ; Cristea, Ecaterina ; Lansky, Alexandra ; Mehran, Roxana ; Dangas, George ; Lazar, Dana ; Sanchez, Raquel ; Fahy, Martin ; Xu, Ke ; Stone, Gregg W. / Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention : Analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. In: Journal of the American College of Cardiology. 2011 ; Vol. 57, No. 24. pp. 2389-2397.
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abstract = "Objectives: We sought to investigate the predictive value of the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score (SS) for risk assessment of 1-year clinical outcomes in patients with nonST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention (PCI). Background: In the SYNTAX trial, the SS was effective in risk-stratifying patients with left main and triple-vessel coronary disease, the majority of whom had stable ischemic heart disease. Methods: The SS was determined in 2,627 patients with nonST-segment elevation acute coronary syndromes undergoing PCI in the angiographic substudy of the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. Patients were stratified according to tertiles of the SS: <7 (n = 854), <7 and <13 (n = 825), and <13 (n = 948). Results: Among patients in the first, second, and third SS tertiles, the 1-year rates of mortality were 1.5{\%}, 1.6{\%}, and 4.0{\%}, respectively (p = 0.0005); the cardiac mortality rates were 0.2{\%}, 0.9{\%}, and 2.7{\%}, respectively (p < 0.0001); the myocardial infarction (MI) rates were 6.3{\%}, 8.3{\%}, and 12.9{\%}, respectively (p < 0.0001); and the target vessel revascularization (TVR) rates were 7.4{\%}, 7.0{\%}, and 9.8{\%}, respectively (p = 0.02). By multivariable analysis, the SS was an independent predictor of 1-year death (hazard ratio [HR]: 1.04, 95{\%} confidence interval [CI]: 1.01 to 1.07; p = 0.005), cardiac death (HR: 1.06, 95{\%} CI: 1.03 to 1.09; p = 0.0002), MI (HR: 1.03, 95{\%} CI: 1.02 to 1.05; p < 0.0001), and TVR (HR: 1.03, 95{\%} CI: 1.02 to 1.05; p < 0.0001). The SS affected death, cardiac death, and MI both within the first 30 days after PCI and between 30 days and 1 year, whereas it affected TVR primarily within the first 30 days. The predictive value of an increased SS was consistent among multiple pre-specified subgroups. Conclusions: In patients with nonST-segment elevation acute coronary syndromes undergoing PCI, the SS is an independent predictor of the 1-year rates of death, cardiac death, MI, and TVR. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158)",
author = "Tullio Palmerini and Philippe Genereux and Adriano Caixeta and Ecaterina Cristea and Alexandra Lansky and Roxana Mehran and George Dangas and Dana Lazar and Raquel Sanchez and Martin Fahy and Ke Xu and Stone, {Gregg W.}",
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Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention : Analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. / Palmerini, Tullio; Genereux, Philippe; Caixeta, Adriano; Cristea, Ecaterina; Lansky, Alexandra; Mehran, Roxana; Dangas, George; Lazar, Dana; Sanchez, Raquel; Fahy, Martin; Xu, Ke; Stone, Gregg W.

In: Journal of the American College of Cardiology, Vol. 57, No. 24, 14.06.2011, p. 2389-2397.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention

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

AU - Palmerini, Tullio

AU - Genereux, Philippe

AU - Caixeta, Adriano

AU - Cristea, Ecaterina

AU - Lansky, Alexandra

AU - Mehran, Roxana

AU - Dangas, George

AU - Lazar, Dana

AU - Sanchez, Raquel

AU - Fahy, Martin

AU - Xu, Ke

AU - Stone, Gregg W.

PY - 2011/6/14

Y1 - 2011/6/14

N2 - Objectives: We sought to investigate the predictive value of the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score (SS) for risk assessment of 1-year clinical outcomes in patients with nonST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention (PCI). Background: In the SYNTAX trial, the SS was effective in risk-stratifying patients with left main and triple-vessel coronary disease, the majority of whom had stable ischemic heart disease. Methods: The SS was determined in 2,627 patients with nonST-segment elevation acute coronary syndromes undergoing PCI in the angiographic substudy of the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. Patients were stratified according to tertiles of the SS: <7 (n = 854), <7 and <13 (n = 825), and <13 (n = 948). Results: Among patients in the first, second, and third SS tertiles, the 1-year rates of mortality were 1.5%, 1.6%, and 4.0%, respectively (p = 0.0005); the cardiac mortality rates were 0.2%, 0.9%, and 2.7%, respectively (p < 0.0001); the myocardial infarction (MI) rates were 6.3%, 8.3%, and 12.9%, respectively (p < 0.0001); and the target vessel revascularization (TVR) rates were 7.4%, 7.0%, and 9.8%, respectively (p = 0.02). By multivariable analysis, the SS was an independent predictor of 1-year death (hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.01 to 1.07; p = 0.005), cardiac death (HR: 1.06, 95% CI: 1.03 to 1.09; p = 0.0002), MI (HR: 1.03, 95% CI: 1.02 to 1.05; p < 0.0001), and TVR (HR: 1.03, 95% CI: 1.02 to 1.05; p < 0.0001). The SS affected death, cardiac death, and MI both within the first 30 days after PCI and between 30 days and 1 year, whereas it affected TVR primarily within the first 30 days. The predictive value of an increased SS was consistent among multiple pre-specified subgroups. Conclusions: In patients with nonST-segment elevation acute coronary syndromes undergoing PCI, the SS is an independent predictor of the 1-year rates of death, cardiac death, MI, and TVR. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158)

AB - Objectives: We sought to investigate the predictive value of the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score (SS) for risk assessment of 1-year clinical outcomes in patients with nonST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention (PCI). Background: In the SYNTAX trial, the SS was effective in risk-stratifying patients with left main and triple-vessel coronary disease, the majority of whom had stable ischemic heart disease. Methods: The SS was determined in 2,627 patients with nonST-segment elevation acute coronary syndromes undergoing PCI in the angiographic substudy of the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. Patients were stratified according to tertiles of the SS: <7 (n = 854), <7 and <13 (n = 825), and <13 (n = 948). Results: Among patients in the first, second, and third SS tertiles, the 1-year rates of mortality were 1.5%, 1.6%, and 4.0%, respectively (p = 0.0005); the cardiac mortality rates were 0.2%, 0.9%, and 2.7%, respectively (p < 0.0001); the myocardial infarction (MI) rates were 6.3%, 8.3%, and 12.9%, respectively (p < 0.0001); and the target vessel revascularization (TVR) rates were 7.4%, 7.0%, and 9.8%, respectively (p = 0.02). By multivariable analysis, the SS was an independent predictor of 1-year death (hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.01 to 1.07; p = 0.005), cardiac death (HR: 1.06, 95% CI: 1.03 to 1.09; p = 0.0002), MI (HR: 1.03, 95% CI: 1.02 to 1.05; p < 0.0001), and TVR (HR: 1.03, 95% CI: 1.02 to 1.05; p < 0.0001). The SS affected death, cardiac death, and MI both within the first 30 days after PCI and between 30 days and 1 year, whereas it affected TVR primarily within the first 30 days. The predictive value of an increased SS was consistent among multiple pre-specified subgroups. Conclusions: In patients with nonST-segment elevation acute coronary syndromes undergoing PCI, the SS is an independent predictor of the 1-year rates of death, cardiac death, MI, and TVR. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158)

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