Clinical SYNTAX score predicts outcomes of patients undergoing coronary artery bypass grafting

Giovanni Melina, Emiliano Angeloni, Simone Refice, Francesco Monti, Roberto Serdoz, Stefano Rosato, Fulvia Seccareccia, Furio Colivicchi, Roberta Serdoz, Francesco Paneni, Riccardo Sinatra

Research output: Contribution to journalArticle

Abstract

Background The SYNTAX score (SS) is a determinant of outcome in patients undergoing percutaneous coronary intervention. In addition, it has been recently shown that the clinical SYNTAX score (cSS), obtained by adding clinical variables to the SS, improves the predictive power of the resulting risk model. We assessed the hypothesis that the use of the cSS may predict outcomes of patients undergoing coronary artery bypass grafting (CABG). Methods We measured the SYNTAX score in 874 patients undergoing isolated first time on-pump CABG. The clinical SYNTAX score was calculated at the time of the study using age, creatinine clearance and ejection fraction, the modified ACEF score, and analyses performed for major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality at 3-year follow-up. Results The mean age of the study population was 70.9 ± 8.1 years, and the median cSS 14.2 (range 2.1–286.5). The ROC curve analysis showed that a cSS >14.5 (81.4% sensitivity and 67.8% specificity) was a reliable tool in discrimination of patients for the occurrence of MACCE (AUC 0.78) and all-cause mortality (AUC 0.74). Kaplan-Meier survival analysis confirmed that patients belonging to higher cSS quartiles have poorer 3-year survival (P =.0001) and MACCE-free survival (P =.0001), with respect to those with lower cSS. Conclusions This observational study has shown that the clinical SYNTAX score, incorporating the lesion-based SS and clinical-based ACEF score, predicted mid-term adverse outcomes of patients undergoing CABG and may play an important role in the risk stratification of this population. Further studies are needed to confirm these findings.

Original languageEnglish
Pages (from-to)118-126
Number of pages9
JournalAmerican Heart Journal
Volume188
DOIs
Publication statusPublished - Jun 1 2017

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Coronary Artery Bypass
ROC Curve
Area Under Curve
Time and Motion Studies
Mortality
Kaplan-Meier Estimate
Percutaneous Coronary Intervention
Survival Analysis
Population
Disease-Free Survival
Observational Studies
Creatinine
Sensitivity and Specificity
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Clinical SYNTAX score predicts outcomes of patients undergoing coronary artery bypass grafting. / Melina, Giovanni; Angeloni, Emiliano; Refice, Simone; Monti, Francesco; Serdoz, Roberto; Rosato, Stefano; Seccareccia, Fulvia; Colivicchi, Furio; Serdoz, Roberta; Paneni, Francesco; Sinatra, Riccardo.

In: American Heart Journal, Vol. 188, 01.06.2017, p. 118-126.

Research output: Contribution to journalArticle

Melina, G, Angeloni, E, Refice, S, Monti, F, Serdoz, R, Rosato, S, Seccareccia, F, Colivicchi, F, Serdoz, R, Paneni, F & Sinatra, R 2017, 'Clinical SYNTAX score predicts outcomes of patients undergoing coronary artery bypass grafting', American Heart Journal, vol. 188, pp. 118-126. https://doi.org/10.1016/j.ahj.2017.03.016
Melina, Giovanni ; Angeloni, Emiliano ; Refice, Simone ; Monti, Francesco ; Serdoz, Roberto ; Rosato, Stefano ; Seccareccia, Fulvia ; Colivicchi, Furio ; Serdoz, Roberta ; Paneni, Francesco ; Sinatra, Riccardo. / Clinical SYNTAX score predicts outcomes of patients undergoing coronary artery bypass grafting. In: American Heart Journal. 2017 ; Vol. 188. pp. 118-126.
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AU - Melina, Giovanni

AU - Angeloni, Emiliano

AU - Refice, Simone

AU - Monti, Francesco

AU - Serdoz, Roberto

AU - Rosato, Stefano

AU - Seccareccia, Fulvia

AU - Colivicchi, Furio

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AU - Paneni, Francesco

AU - Sinatra, Riccardo

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N2 - Background The SYNTAX score (SS) is a determinant of outcome in patients undergoing percutaneous coronary intervention. In addition, it has been recently shown that the clinical SYNTAX score (cSS), obtained by adding clinical variables to the SS, improves the predictive power of the resulting risk model. We assessed the hypothesis that the use of the cSS may predict outcomes of patients undergoing coronary artery bypass grafting (CABG). Methods We measured the SYNTAX score in 874 patients undergoing isolated first time on-pump CABG. The clinical SYNTAX score was calculated at the time of the study using age, creatinine clearance and ejection fraction, the modified ACEF score, and analyses performed for major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality at 3-year follow-up. Results The mean age of the study population was 70.9 ± 8.1 years, and the median cSS 14.2 (range 2.1–286.5). The ROC curve analysis showed that a cSS >14.5 (81.4% sensitivity and 67.8% specificity) was a reliable tool in discrimination of patients for the occurrence of MACCE (AUC 0.78) and all-cause mortality (AUC 0.74). Kaplan-Meier survival analysis confirmed that patients belonging to higher cSS quartiles have poorer 3-year survival (P =.0001) and MACCE-free survival (P =.0001), with respect to those with lower cSS. Conclusions This observational study has shown that the clinical SYNTAX score, incorporating the lesion-based SS and clinical-based ACEF score, predicted mid-term adverse outcomes of patients undergoing CABG and may play an important role in the risk stratification of this population. Further studies are needed to confirm these findings.

AB - Background The SYNTAX score (SS) is a determinant of outcome in patients undergoing percutaneous coronary intervention. In addition, it has been recently shown that the clinical SYNTAX score (cSS), obtained by adding clinical variables to the SS, improves the predictive power of the resulting risk model. We assessed the hypothesis that the use of the cSS may predict outcomes of patients undergoing coronary artery bypass grafting (CABG). Methods We measured the SYNTAX score in 874 patients undergoing isolated first time on-pump CABG. The clinical SYNTAX score was calculated at the time of the study using age, creatinine clearance and ejection fraction, the modified ACEF score, and analyses performed for major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality at 3-year follow-up. Results The mean age of the study population was 70.9 ± 8.1 years, and the median cSS 14.2 (range 2.1–286.5). The ROC curve analysis showed that a cSS >14.5 (81.4% sensitivity and 67.8% specificity) was a reliable tool in discrimination of patients for the occurrence of MACCE (AUC 0.78) and all-cause mortality (AUC 0.74). Kaplan-Meier survival analysis confirmed that patients belonging to higher cSS quartiles have poorer 3-year survival (P =.0001) and MACCE-free survival (P =.0001), with respect to those with lower cSS. Conclusions This observational study has shown that the clinical SYNTAX score, incorporating the lesion-based SS and clinical-based ACEF score, predicted mid-term adverse outcomes of patients undergoing CABG and may play an important role in the risk stratification of this population. Further studies are needed to confirm these findings.

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