Author + information
- Bjorn Redfors1,
- Tullio Palmerini2,
- Adriano Caixeta3,
- Girma Ayele4,
- Dominic Francese1,
- Roxana Mehran5,
- Emmanouil Brilakis6,
- Ajay Kirtane7,
- Dimitri Karmpaliotis7,
- Gregg Stone8 and
- Philippe Généreux9
- 1CRF, New York, New York, United States
- 2Policlinico S. Orsola, Bologna, Italy
- 3Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- 4Cardiovascular Research Foundation, New York, New York, United States
- 5Cardiovascular Research Foundation, Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States
- 6Minneapolis Heart Institute, UT Southwestern Medical Center/VA North Texas Health Care System, Dallas, Texas, United States
- 7NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 8Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 9Columbia University Medical Center/Hôpital du Sacré-Coeur de Montréal, New York, New York, United States
The traditional SS algorithm assigns CTO lesions a greater weight (5× points) than non-CTO lesions (50 to <100% diameter stenosis; 2× points). We evaluated the contribution and predictive utility of chronic total occlusions (CTO) in the SYNTAX score (SS).
We calculated the traditional SS and a simplified SS (2× points also for CTO lesions) in 4,356 patients from the angiographic substudy of the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial. We compared the association between SS and 1-year mortality and major adverse cardiac events for patients with and without a CTO. We also compared the simplified SS to the traditional SS.
The median SS was 20 (interquartile range 13 to 27.5) for patients with a CTO and 8 (interquartile range 2 to 16) for patients without a CTO. For patients with a CTO, the CTO lesion(s) contributed 67% ± 26% of the total SS. The simplified SS reclassified 31% (187/603) of patients with a SS >22 to a SS ≤22. The simplified SS was as effective in predicting 1-year outcomes as the traditional SS (Table). Using the traditional SS rather than the simplified SS did not improve net reclassification (0.009, p=0.93) or integrative discrimination (0.001, p=0.83) indices.
|Predictive Abilities of the Traditional and Simplified SYNTAX Score in Regard to Death Within 1 Year|
|Cohort||SYNTAX Score||N||Area Under the Curve||95% Confidence Interval||p Value*|
*Refers to comparison between the traditional and simplified SYNTAX score.
CTO lesions contribute considerably to the total SS in patients with a CTO. A simplified SS that does not differentiate between CTO and non-CTO lesions may be equivalent to the traditional SS for risk prediction, while reclassifying a substantial proportion of patients to a low SS ≤22, potentially impacting choice of revascularization strategy.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)