Impact of the Clinical Syntax Score on 5-year clinical outcomes after sirolimus-eluting stents implantation
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ORIGINAL ARTICLE
Impact of the Clinical Syntax Score on 5-year clinical outcomes after sirolimus-eluting stents implantation Hironori Hara • Jiro Aoki • Kengo Tanabe • Akihiro Nishi • Shuzou Tanimoto • Yoshifumi Nakajima • Kazuyuki Yahagi • Makoto Nakashima • Takuya Hashimoto • Masahiko Asami • Mika Watanabe • Eri Yoshida • Hiroyoshi Nakajima • Kazuhiro Hara
Received: 7 November 2012 / Accepted: 18 January 2013 / Published online: 8 February 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Abstract The SYNTAX score stratifies risk among drugeluting stent-treated patients and is based on lesion characteristics alone. The Clinical SYNTAX Score (CSS) combines the SYNTAX score with age, ejection fraction, and creatinine clearance. We assessed its ability to stratify longterm outcomes in sirolimus-eluting stents (SES)-treated patients. Between August 2004 and March 2005, 249 patients were treated with SES. Clinical follow-up was evaluated at more than 5 years. The CSS was available for 206 patients. More than 5-year clinical follow-up data (mean 2114 ± 107 days) and CSS (range 1–322, mean 35.3 ± 49.9, median 17.5) were available for 201 patients. We divided these scores into tertiles: CSS-LOW B 9.5, 9.5 \ CSS-MID B 28, and CSS-HIGH [ 28. CSS-HIGH was associated with a higher death rate (CSS-LOW 9.0 %, CSSMID 11.9 %, CSS-HIGH 41.8 %; log-rank p \ 0.001) and major adverse cardiovascular events (MACE) (CSS-LOW 29.8 %, CSS-MID 35.8 %, CSS-HIGH 61.2 %; log-rank p = 0.004). Independent predictors for death were hemodialysis [hazard ratio (HR) 3.82; p \ 0.001], age (HR 1.67; p = 0.003), ejection fraction (HR 0.98, p = 0.012) and CSS (HR 1.73, p = 0.028), and those for MACE were hemodialysis (HR 2.53, p = 0.002) and CSS (HR 1.40, p = 0.028). Areas under the curve for the SYNTAX score and CSS for
H. Hara (&) J. Aoki K. Tanabe S. Tanimoto Y. Nakajima K. Yahagi M. Nakashima T. Hashimoto M. Asami M. Watanabe E. Yoshida H. Nakajima K. Hara Division of Cardiology, Mitsui Memorial Hospital, 1, Kanda-Izumicho, Chiyoda-ku, Tokyo 101-8643, Japan e-mail: [email protected] A. Nishi Harvard School of Public Health, Boston, MA, USA
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death were 0.60 and 0.78 (p \ 0.001), whereas those for MACE were 0.58 and 0.68 (p \ 0.001), respectively. The CSS predicts long-term outcomes among SES-treated patients better than the SYNTAX score. Keywords Clinical SYNTAX Score Drug-eluting stent Percutaneous coronary intervention
Introduction The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score was created as an angiographic tool to grade the complexity of coronary artery disease and obtain evidence-based guidelines for selecting the optimal revascularization technique [1, 2]. The SYNTAX score is a useful tool for determining the revascularization strategy in patients with a left main and/or three-vessel disease [3]. In addition, the SYNTAX score has been shown to stratify risk among real-world populations treated with drug-eluting stent
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