Author + information
- Received January 6, 2011
- Revision received February 3, 2011
- Accepted February 7, 2011
- Published online June 14, 2011.
- Tullio Palmerini, MD⁎,†,
- Philippe Genereux, MD†,
- Adriano Caixeta, MD†,
- Ecaterina Cristea, MD†,
- Alexandra Lansky, MD‡,
- Roxana Mehran, MD§,
- George Dangas, MD§,
- Dana Lazar, MD†,
- Raquel Sanchez, MD†,
- Martin Fahy, MSc†,
- Ke Xu, PhD† and
- Gregg W. Stone, MD†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Gregg W. Stone, Columbia University Medical Center, New York-Presbyterian Hospital, The Cardiovascular Research Foundation, 111 East 59th Street, 11th Floor, New York, New York 10022
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 non–ST-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 non–ST-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 non–ST-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)
The ACUITY trial was funded by The Medicines Company and Nycomed. Dr. Mehran is a consultant to Abbott Vascular, AstraZeneca, Cardiva, Cordis, Ortho-McNeil, The Medicines Company, and Regado Biosciences; and has received a research grant from Sanofi/Bristol-Myers Squibb. Dr. Dangas has received honoraria from The Medicines Company, Cordis, and Sanofi/Bristol-Myers Squibb; and is a consultant to AstraZeneca. Mr. Fahy, and Drs. Xu, Cristea, Lazar, and Sanchez are employed by the Cardiovascular Research Foundation. Dr. Stone serves on the scientific advisory boards for and has received honoraria from Abbott Vascular and Boston Scientific; and is a consultant to The Medicines Company. All other authors have reported that they have no relationships to disclose.
- Received January 6, 2011.
- Revision received February 3, 2011.
- Accepted February 7, 2011.
- American College of Cardiology Foundation