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Bettinger N, Palmerini T, Caixeta A, et al. Risk stratification of patients undergoing medical therapy after coronary angiography. Eur Heart J. 2015;37(40):3103-3110doi: 10.1093/eurheartj/ehv674.
Bettinger, N., Palmerini, T., Caixeta, A., Dressler, O., Litherland, C., Francese, D. P., Giustino, G., Mehran, R., Leon, M. B., Stone, G. W., & Généreux, P. (2016). Risk stratification of patients undergoing medical therapy after coronary angiography. European heart journal, 37(40), 3103-3110. https://doi.org/10.1093/eurheartj/ehv674
Bettinger, Nicolas, et al. "Risk stratification of patients undergoing medical therapy after coronary angiography." European heart journal vol. 37,40 (2016): 3103-3110. doi: https://doi.org/10.1093/eurheartj/ehv674
Bettinger N, Palmerini T, Caixeta A, Dressler O, Litherland C, Francese DP, Giustino G, Mehran R, Leon MB, Stone GW, Généreux P. Risk stratification of patients undergoing medical therapy after coronary angiography. Eur Heart J. 2016 Oct 21;37(40):3103-3110. doi: 10.1093/eurheartj/ehv674. Epub 2015 Dec 18. PMID: 26685136.
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Eur Heart J. 2016 Oct 21;37(40):3103-3110. doi: 10.1093/eurheartj/ehv674. Epub 2015 Dec 18.

Risk stratification of patients undergoing medical therapy after coronary angiography.

European heart journal

Nicolas Bettinger, Tullio Palmerini, Adriano Caixeta, Ovidiu Dressler, Claire Litherland, Dominic P Francese, Gennaro Giustino, Roxana Mehran, Martin B Leon, Gregg W Stone, Philippe Généreux

Affiliations

  1. NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
  2. Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY, USA.
  3. Istituto di Cardiologia, Policlinico S. Orsola, University of Bologna, Bologna, Italy.
  4. Hospital Israelita Albert Einstein and Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
  5. Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  6. NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA [email protected].
  7. Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, QC, Canada.

PMID: 26685136 DOI: 10.1093/eurheartj/ehv674

Abstract

AIM: We sought to investigate the prognostic impact of the SYNTAX (Synergy between PCI with TAXUS and Cardiac Surgery) score (SS) on 1-year clinical outcomes in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) undergoing medical therapy only.

METHODS AND RESULTS: Among the 13 819 patients enrolled in the ACUITY trial and undergoing coronary angiogram, 4491 patients were treated with medical therapy as the initial strategy. Of those, baseline SS and complete angiographic analysis were available in 1275 patients. Patients were divided in four groups based on the presence or absence of coronary artery disease (CAD) and subsequently, among patients with CAD, by SS. Major adverse cardiac events (MACE) and its individual components (death, myocardial infarction, and unplanned revascularization) were compared between groups. Among the 1275 patients, the mean SS was 3.5 ± 7.0 (range 0-45). SYNTAX score was 0 in 842 patients, >0 and ≤5 in 170, >5 and ≤11 in 119, and >11 in 144 patients. The 1-year rates of MACE were higher in patients with CAD and higher SS. By multivariable analysis, the SS was a strong predictor of all adverse ischaemic events, including mortality. By receiver operator characteristic analysis, an SS cut-off of 8 showed the best prognostic accuracy for death and MACE.

CONCLUSION: In patients with NSTE ACS undergoing medical therapy, the SS, especially when >8, was shown to be a strong predictor of 1-year MACE, including mortality. This finding has important clinical implications for risk stratification of patients with NSTE ACS undergoing medical therapy after an initial angiogram.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: [email protected].

Keywords: Medical therapy; Non-ST-elevation acute coronary syndromes; SYNTAX score

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