The SYNTAX score and the coronary artery calcium score for the prediction of clinical outcomes in patients undergoing percutaneous coronary intervention

RONG, Yaocong; LI, Tianqi; CHEN, Yang; LIU, Hongyuan; HONG, Weilin; GUAN, Shaofeng; HAN, Wenzheng; GAN, Qian; ZHANG, Liang; CHANG, Xifeng; KONG, Chengqi; WENG, Tingwen; SHI, Chuan; ZHANG, Youjun; QU, Xinkai

doi:10.1590/fst.29621

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Original Article • Food Sci. Technol (Campinas) 42 • 2022 • https://doi.org/10.1590/fst.29621 copy

The SYNTAX score and the coronary artery calcium score for the prediction of clinical outcomes in patients undergoing percutaneous coronary intervention

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aims to investigate the predictive value of SYNTAX score,SYNTAX score II and coronary artery calcium score on the prognosis of patients after PCI. The SYNTAX score, SYNTAX score II and coronary artery calcium score were calculated. The primary end point was major adverse cardiac and cerebrovascular events (MACCE). 195 patients were included, 182 patients were followed up and the median follow-up time was 34.5 months. The MACCE occurred in 30 patients. The incidence of MACCE of lower risk, medium risk and high risk were: SYNTAX score: 6.7%, 18.3%, 24.2%; coronary artery calcium score: 9.7%, 18.3%, 21.7%; SYNTAX score II: 6.6%, 16.4%, 26.7%; new combined risk score: 7.7%, 8.1%, and 35.8%. ROC analysis showed that SYNTAX score (AUC: 0.641, 95%CI: 0.540-0.743), coronary artery calcium score (AUC: 0.597, 95%CI: 0.490 -0.704), SYNTAX score II (AUC: 0.662, 95%CI: 0.561 - 0.763), new combined risk score (0.711, 95%CI: 0.606 - 0.816). The new combined risk score tended to be superior compared to other risk score (p<0.01). The results suggested that SYNTAX score, SYNTAX score II and new combined risk score can predict the occurrence of MACCE after PCI, new combined risk score provides superior prediction.

Keywords:
SYNTAX score; SYNTAX score II; Coronary artery calcium score; percutaneous coronary intervention; major adverse cardiac and cerebrovascular events

Characteristics	Total	Non-MACCE	MACCE	P value
Characteristics	(n=182)	(n=152)	(n=30)	P value
Age (years)	68.4±9.4	68.0±9.6	70.5±8.2	0.23
Male [case (%)]	130(71.4%)	108(71.1%)	22(73.3%)	0.8
Body mass index (kg/m2)	24.4±3.0	24.4±3.1	24.1±2.6	0.3
Left ventricular ejection fraction(%)	63(60/66)	63(60/66)	63(60/66)	0.68
Creatinine clearance (ml/min)	76.6±24.0	78.7±24.1	66.2±21.0	<0.01
Diabetes (%)	49(26.9%)	41(27.0%)	8(26.7%)	0.37
Hypertension (%)	137(75.2%)	113(74.3%)	24(80%)	0.51
Abnormal blood lipid metabolism (%)	33(18.1%)	27(17.8%)	6(20%)	0.77
Triglyceride (mmol/L)	1.5±0.7	1.5±0.7	1.6±0.8	0.72
Total cholesterol (mmol/L)	4.0(3.2/5.0)	4.0(3.3/4.7)	4.2(3.2/5.4)	0.51
High density lipoprotein (mmo/L)	1.0(1.0/1.1)	1.1(0.9/1.3)	1.1(1.0/1.2)	0.51
Low density lipoprotein (mmol/L)	2.4±0.9	2.3±0.9	2.5±1.1	0.55
Current smoking [cases (%)]	60(33%)	46(30.1%)	14(46.7%)	0.08
SYNTAX	12(8/21)	11(8/20)	17(13/23)	<0.01
SYNTAX II	28(21.75/35)	26.9(20.8/33)	33.(29.1/40)	<0.01
Calcium score	113(61.8/339.5)	110(57.8/322)	227(106/614)	0.02
Stable angina	79(43.4%)	68(44.8%)	11(36.7%)	0.42
Unstable angina	83(45.6%)	67(44.1%)	16(53.3%)	0.41
NSTEMI	20(11%)	17(11.2%)	3(10%)	0.78
Aspirin [cases (%)]	170(93.4%)	141(92.7%)	27(90%)	0.51
Clopidogrel [cases (%)]	176(96.7%)	143(94.6%)	28(93.3%)	0.59
ACEI/ARB [(%)]	61(33.5%)	50(32.9%)	11(36.7%)	0.69
Beta blocker [case (%)]	54(29.7%)	44(28.9%)	10(33.3%)	0.63
Statins [cases (%)]	127(69.8%)	108(71%)	19(63.3%)	0.4

Characteristics	Total	Non-MACCE	MACCE	P value
Characteristics	(n=182)	(n=152)	(n=30)	P value
Number of lesions
Single-vessel lesion (%)	78(42.9%)	68(44.7%)	10(33.3%)	0.25
Two-vessel lesions (%)	68(37.3%)	58(38.2%)	10(33.3%)	0.62
Three-vessel disease (%)	36(19.8%)	26(17.1%)	10(33.3%)	0.04
Lesion
Left trunk (%)	16(8.8%)	12(7.9%)	4(13.3%)	0.26
Left anterior descending artery (%)	132(72.5%)	109(71.7%)	25(83.3%)	0.99
Circumflex artery (%)	81(44.5%)	61(40.1%)	15(50%)	0.99
Right coronary artery (%)	92(50.5%)	74(48.7%)	18(60%)	0.1
Lesion characteristics
Bifurcation (%)	12(6.6%)	10(6.6%)	2(6.7%)
Chronic complete occlusion (%)	16(8.8%)	13(8.6%)	3(10%)
Number of stents inserted	1(1/2)	1(1/2)	2(1/2)

Items	Low-risk	Medium-risk	High-risk	P value
Items	(n = 60)	(n = 60)	(n = 62)	P value
MACCE	4(6.7%)	11(18.3%)	15(24.2%)	0.029
All-cause death	1(1.7%)	5(8.3%)	6(9.7%)	0.06
Cardiogenic death	1(1.7%)	5(8.3%)	3(4.8%)	0.282
Non-fatal myocardial infarction	0(0%)	1(1.7%)	4(6.5%)	0.037
Revascularization again	2(3.3%)	6(10%)	6(9.7%)	0.129
Stroke	1(1.7%)	0(0%)	1(1.6%)	0.659

Items	Low-risk	Medium-risk	High-risk	P value
Items	(n = 62)	(n = 60)	(n = 60)	P value
MACCE	6(9.7%)	11(18.3%)	13(21.7%)	0.176
All-cause death	1(1.6%)	5(8.3%)	6(10%)	0.05
Cardiogenic death	0(0%)	4(6.7%)	5(8.3%)	0.026
Non-fatal myocardial infarction	0(0%)	3(5%)	2(3.3%)	0.199
Revascularization again	3(4.8%)	4(6.7%)	7(11.7%)	0.108
Stroke	2(3.2%)	0(0%)	0(0%)	0.115

Items	Low-risk	Medium-risk	High-risk	P value
Items	(n = 61)	(n = 61)	(n = 60)	P value
MACCE	4(6.6%)	10(16.4%)	16(26.7%)	0.012
All-cause death	2(3.3%)	3(4.9%)	7(11.7%)	0.047
Cardiogenic death	1(1.6%)	3(4.9%)	5(8.3%)	0.069
Non-fatal myocardial infarction	0(0%)	1(1.6%)	4(6.7%)	0.022
Revascularization again	1(1.6%)	7(11.5%)	6(10%)	0.059
Stroke	0(0%)	1(1.6%)	1(1.7%)	0.33

Items	Low-risk	Medium-risk	High-risk	P value
Items	(n = 52)	(n = 74)	(n = 56)	P value
MACCE	4(7.7%)	6(8.1%)	20(35.8%)	<0.01
All-cause death	1(1.9%)	2(2.7%)	9(16.1%)	<0.01
Cardiogenic death	1(1.9%)	1(1.4%)	7(12.5%)	<0.01
Non-fatal myocardial infarction	0(0%)	0(0%)	5(8.9%)	<0.01
Revascularization again	2(3.8%)	3(4.1%)	9(16.1%)	0.012
Stroke	1(1.9%)	1(1.4%)	0(0%)	0.314

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[1] *Corresponding author: xinkaiqu20@sina.com