Angiographic score assessment improves cardiovascular risk prediction: the clinical value of SYNTAX and Gensini application

作者：Sinning Christoph; Lillpopp Lars; Appelbaum Sebastian; Ojeda Francisco; Zeller Tanja; Schnabel Renate; Lubos Edith; Jagodzinski Annika; Keller Till; Munzel Thomas; Bickel Christoph; Blankenberg Stefan^*

来源：Clinical Research in Cardiology, 2013, 102(7): 495-503.

DOI：10.1007/s00392-013-0555-4

• Coronary artery disease
• Prognosis
• Risk stratification
• SYNTAX score
• Gensini score

Severity of coronary artery disease (CAD) is related to cardiovascular outcome. We aimed to assess the long-term follow-up depending on Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) and Gensini score for prognosis. Both scores increase with complexity and thus reflect risk of cardiovascular events. %26lt;br%26gt;We determined complexity and extent of CAD by the SYNTAX and Gensini score in the AtheroGene cohort (N = 1,974, with 22.6 % women). The endpoint was non-fatal myocardial infarction (N = 132) and cardiovascular death (N = 159) over a median follow-up of 5.4 (Q1: 5.23/Q3: 5.57) years up to 8 years maximum (follow-up rate 99.4 %). %26lt;br%26gt;For SYNTAX score, the following distribution was used: low (a parts per thousand currency sign22, N = 1,404), medium (23-32, N = 314), high score (%26gt; 32, N = 256). Gensini score was split into thirds. Cox regression analysis showed a hazard ratio (HR) of 1.5 (95 % confidence interval 1.16-1.95; p = 0.0024) for the log transformed SYNTAX score in a fully adjusted model and a HR of 1.41 (95 % CI 1.13-1.77; p = 0.0025) for the Gensini score. The SYNTAX score alone had a C-index of 0.62, whereas adding clinical variables increased the C-index to 0.67. Similar results were obtained for the Gensini score. Regarding the SYNTAX score using net reclassification index, discrimination of events and non-events was enhanced by 37.2 % in a model of clinical variables and biomarkers and by 31.8 % for the Gensini score. %26lt;br%26gt;The SYNTAX and Gensini score in combination with clinical variables could be used to predict the cardiovascular prognosis during a long-term follow-up of up to 8 years in CAD patients.

• 出版日期2013-7