Abstract
Background
Risk scores, like the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (SS), clinical SS, logistic SS (core model and
extended model [LSSextended]), Age, Creatinine, and Ejection Fraction (ACEF) score, and modified ACEF score, are predictive for major adverse cardiac
events (MACE; including all-cause mortality, myocardial infarction [MI], and revascularization)
in patients who have undergone percutaneous coronary intervention (PCI). However,
few studies have validated the performance of these scores in complete revascularization
(CR) patients. We aimed to compare the performance of previous risk scores in patients
who achieved CR after PCI.
Methods
All patients (N = 10,724) who underwent PCI at Fuwai Hospital in 2013 were screened,
and those who achieved CR after PCI were enrolled. Risk scores were calculated by
experienced cardiologists blinded to the clinical outcomes. Discrimination of risk
scores was assessed according to the area under the receiver operating characteristic
curve (AUC).
Results
Fifty-one percent (5375/10,724) of patients who underwent PCI achieved CR. At a mean
follow-up of 2.4 years, the mortality, MI, revascularization, and MACE rates were
1.2%, 1.0%, 6.3%, and 7.7%, respectively. SS was not predictive for mortality (AUC,
0.51; 95% confidence interval [CI], 0.44-0.59). All scores involving clinical variables,
especially modified ACEF score (AUC, 0.73; 95% CI, 0.66-0.79), could predict mortality.
LSSextended was the most accurate for MI (AUC, 0.68; 95% CI, 0.61-0.75). SS and LSSextended were predictive for revascularization, with marginally significant AUCs (SS, 0.54;
LSSextended, 0.55). No score was particularly accurate for predicting MACE, with AUCs ranging
from 0.51 (ACEF score) to 0.58 (LSSextended).
Conclusions
In CR patients, risk scores involving clinical variables might help to predict mortality;
however, no risk scores showed helpful discrimination for MACE.
Résumé
Contexte
Les scores de risque comme le score SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) (SS), le SS clinique, le SS logistique (modèle de base et modèle étendu [LSSétendu]), le score ACEF (Age, Creatinine, and Ejection Fraction) (ACEF) et le score ACEF modifié, permettent de prédire les événements cardiaques
indésirables majeurs (ECIM, y compris la mortalité toutes causes confondues, l'infarctus
du myocarde [IM] et la revascularisation) chez les patients ayant subi une intervention
coronarienne percutanée (ICP). Toutefois, rares sont les études qui ont confirmé l'efficacité
de ces scores chez les patients ayant obtenu une revascularisation complète (RC).
Nous avons voulu comparer l'efficacité des scores de risque susmentionnés chez des
patients ayant obtenu une RC après une ICP.
Méthodologie
Tous les patients (N = 10 724) ayant subi une ICP en 2013 à l'hôpital Fuwai ont été
examinés et ceux qui ont obtenu une RC après une ICP ont été inclus dans l'étude.
Les scores de risque ont été calculés par des cardiologues expérimentés qui n'étaient
pas informés des issues cliniques de l'intervention. La discrimination des scores
de risque a été évaluée par l'aire sous la courbe (ASC) ROC (receiver operating characteristic).
Résultats
Cinquante et un pour cent (5375/10 724) des patients ayant subi une ICP ont obtenu
une RC. Après une période de suivi moyenne de 2,4 ans, les taux de mortalité, d'IM,
de revascularisation et d'ECIM étaient de 1,2 %, 1,0 %, 6,3% et 7,7 %, respectivement.
Le SS ne permettait pas de prédire la mortalité (ASC, 0,51; intervalle de confiance
[IC] à 95 %, de 0,44 à 0,59). Tous les scores tenant compte de variables cliniques,
en particulier le score ACEF modifié (ASC, 0,73; IC à 95 %, de 0,66 à 0,79), étaient
prédictifs de la mortalité. Le LSSétendu était le plus précis pour l'IM (ASC, 0,68; IC à 95 %, de 0,61 à 0,75). Le SS et le
LSSétendu étaient prédictifs de la revascularisation, avec des valeurs de l'ASC marginalement
significatives (SS, 0,54; LSSétendu, 0,55). Aucun score n'a permis de prédire de façon particulièrement précise la survenue
des ECIM, pour lesquels la valeur de l'ASC variait de 0,51 (score ACEF ) à 0,58 (LSSétendu).
Conclusions
Chez les patients RC, les scores de risque tenant compte de variables cliniques pourraient
contribuer à prédire la mortalité; toutefois, aucun score de risque ne présentait
une discrimination suffisante pour prédire la survenue des ECIM.
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References
- Usefulness of the SYNTAX and clinical SYNTAX scores in predicting clinical outcome after unrestricted use of sirolimus- and everolimus-eluting Stents.Circ J. 2013; 77: 2912-2921
- Long-term outcomes of complete versus incomplete revascularization for patients with multivessel coronary artery disease and left ventricular systolic dysfunction in drug-eluting stent era.J Korean Med Sci. 2014; 29: 1501-1506
- Benefit of complete revascularization in patients with multivessel coronary disease in the drug-eluting stent era.Circ J. 2012; 76: 1624-1630
- Effect of complete revascularization on 10-year survival of patients with stable multivessel coronary artery disease: MASS II trial.Circulation. 2012; 126: S158-S163
- Quantification of incomplete revascularization and its association with five-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial validation of the residual SYNTAX score.Circulation. 2013; 128: 141-151
- Assessment of the SYNTAX score in the Syntax study.EuroIntervention. 2009; 5: 50-56
- A new tool for the risk stratification of patients with complex coronary artery disease: the Clinical SYNTAX Score.Circ Cardiovasc Interv. 2010; 3: 317-326
- Combined anatomical and clinical factors for the long-term risk stratification of patients undergoing percutaneous coronary intervention: the Logistic Clinical SYNTAX score.Eur Heart J. 2012; 33: 3098-3104
- Risk of assessing mortality risk in elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony.Circulation. 2009; 119: 3053-3061
- Value of age, creatinine, and ejection fraction (ACEF score) in assessing risk in patients undergoing percutaneous coronary interventions in the ‘All-Comers’ LEADERS trial.Circ Cardiovasc Interv. 2011; 4: 47-56
- The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease.EuroIntervention. 2005; 1: 219-227
- 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 Cardiovasc Interv. 2013; 6: 737-745
- The applicability of eGFR equations to different populations.Nat Rev Nephrol. 2013; 9: 513-522
- Clinical end points in coronary stent trials: a case for standardized definitions.Circulation. 2007; 115: 2344-2351
- Use and misuse of the receiver operating characteristic curve in risk prediction.Circulation. 2007; 115: 928-935
- Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.Biometrics. 1988; 44: 837-845
- Assessing calibration of prognostic risk scores.Stat Methods Med Res. 2016; 25: 1692-1706
- Using relative utility curves to evaluate risk prediction.J R Stat Soc Ser A Stat Soc. 2009; 172: 729-748
- Evaluating a new marker for risk prediction: decision analysis to the rescue.Discov Med. 2012; 14: 181-188
- Assessing the performance of prediction models: a framework for traditional and novel measures.Epidemiology. 2010; 21: 128-138
- Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimation.Stat Med. 2004; 23: 2109-2123
- Complete myocardial revascularization confers a larger clinical benefit when performed with state-of-the-art techniques in high-risk patients with multivessel coronary artery disease: a meta-analysis of randomized and observational studies.Catheter Cardiovasc Interv. 2016; 87: 3-12
- 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 64: e139-228
- 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions.Circulation. 2011; 124: e574-651
- Usefulness of the baseline syntax score to predict 3-year outcome after complete revascularization by percutaneous coronary intervention.Am J Cardiol. 2016; 118: 641-646
- Discrimination and calibration of clinical prediction models: users’ guides to the medical literature.JAMA. 2017; 318: 1377-1384
- Antiplatelet therapy in acute coronary syndrome (ACS): applying new science to clinical decisions.Am J Cardiol. 2010; 106: S2-3
- Predictors of low clopidogrel adherence following percutaneous coronary intervention.Am J Cardiol. 2011; 108: 822-827
- Clinical outcome of patients with and without diabetes mellitus after percutaneous coronary intervention with the resolute zotarolimus-eluting stent: 2-year results from the prospectively pooled analysis of the international global RESOLUTE program.JACC Cardiovasc Interv. 2013; 6: 357-368
- Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure.J Clin Epidemiol. 2004; 57: 1096-1103
- Comparison of self-report, hospital discharge codes, and adjudication of cardiovascular events in the Women’s Health Initiative.Am J Epidemiol. 2004; 160: 1152-1158
Article info
Publication history
Published online: February 26, 2019
Accepted:
February 20,
2019
Received:
December 14,
2018
Footnotes
See page 1067 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
