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

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Abstract

Background

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.

Methods and results

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 %).

For SYNTAX score, the following distribution was used: low (≤22, N = 1,404), medium (23–32, N = 314), high score (>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.

Conclusion

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.

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Abbreviations

ACS:

Acute coronary syndrome

CAD:

Coronary artery disease

CABG:

Coronary artery bypass grafting

CI:

Confidence interval

CRP:

C-reactive protein

HDL-cholesterol:

High density lipoprotein

HR:

Hazard ratio

LDL-cholesterol:

Low density lipoprotein

Nt-proBNP:

N-terminal pro B-type natriuretic peptide

NRI:

Net reclassification improvement

NSTEMI:

Non-ST-segment elevation infarction

PCI:

Percutaneous coronary intervention

SD:

Standard deviation

STEMI:

ST segment elevation infarction

SYNTAX:

Synergy between percutaneous coronary intervention with taxus and cardiac surgery

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Acknowledgments

The AtheroGene study is supported by a Grant of the “Stiftung Rheinland-Pfalz für Innovation”, Ministry of Science and Education (AZ 15202-386261/545), Mainz, Germany, and by a Grant from the Fondation de France (no. 2002004994).

Conflict of interest

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany

    Christoph Sinning, Sebastian Appelbaum, Francisco Ojeda, Tanja Zeller, Renate Schnabel, Edith Lubos, Annika Jagodzinski, Till Keller & Stefan Blankenberg

  2. II Department of Medicine, University Medical Center, Johannes Gutenberg University, Mainz, Germany

    Lars Lillpopp, Thomas Munzel & Christoph Bickel

  3. Department of Internal Medicine, Federal Armed Forces Central Hospital, Rübenacher Str. 170, 56072, Koblenz, Germany

    Christoph Bickel

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  1. Christoph Sinning
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Correspondence to Stefan Blankenberg.

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For the AtheroGene Study.

C. Bickel and S. Blankenberg contributed equally to this work.

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Sinning, C., Lillpopp, L., Appelbaum, S. et al. Angiographic score assessment improves cardiovascular risk prediction: the clinical value of SYNTAX and Gensini application. Clin Res Cardiol 102, 495–503 (2013). https://doi.org/10.1007/s00392-013-0555-4

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