Risk stratification in 3-vessel coronary artery disease: Applying the SYNTAX Score II in the Heart Team Discussion of the SYNTAXII trial

Abstract Background Hypoalbuminemia was reported to be associated with poor prognosis in severe diseases. Triple-vessel coronary artery disease (TVD) has high risk of death. We aimed to evaluate the predictive value of hypoalbuminemia in TVD patients. Methods A total of 8,943 consecutive TVD patients were enrolled from April 2004 to February 2011. The primary endpoint was all-cause death and the secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE; a composite of all-cause death, myocardial infarction or stroke). Patients were divided into two groups according to normal serum albumin level (<4.0 g/dL and ≥4.0 g/dL). Results During the median of follow-up 7.5 years, 1365 deaths and 2354 MACCE occurred. Multivariate Cox regression indicated that hypoalbuminaemia (<4.0 g/dL) was an independent predictor of all-cause death (HR 1.30, 95% CI 1.14–1.50, P<0.001) and MACCE (HR 1.19, 95% CI 1.07–1.32, P<0.001). Adjustment of the all-cause death risk estimated by albumin improved the predictive value of SYNTAX score (AUC from 0.585 to 0.602, P=0.002; IDI=0.005, P<0.001; NRI=0.205, P<0.001). For SYNTAX II score, improvement was shown for NRI and IDI but not for AUC (SYNTAX II for PCI: IDI=0.003, P<0.001; NRI=0.205, P<0.001; AUC from 0.711 to 0.713, P=0.257; SYNTAX II for CABG: IDI=0.002, P<0.001; NRI=0.205, P<0.001; AUC from 0.696 to 0.698, P=0.120). Predictive value for all-cause death using the AUC, NRI and IDI AUC (95% CI) P value NRI (95% CI) P value IDI (95% CI) P value SYNTAX 0.585 (0.568–0.602) Ref. Ref. – Ref. – SYNTAX + albumin 0.602 (0.586–0.619) 0.002 0.205 (0.145–0.264) <0.001 0.005 (0.004–0.007) <0.001 SYNTAX II (for PCI) 0.711 (0.696–0.726) Ref. Ref. – Ref. – SYNTAX II (for PCI) + albumin 0.713 (0.698–0.728) 0.257 0.205 (0.145–0.264) <0.001 0.003 (0.001–0.004) <0.001 SYNTAX II (for CABG) 0.696 (0.680–0.711) Ref. Ref. – Ref. – SYNTAX II (for CABG) + albumin 0.698 (0.683–0.714) 0.120 0.205 (0.145–0.264) <0.001 0.002 (0.001–0.004) <0.001 Multi-factor adjusted KM analysis in TVD Conclusions For TVD patients, hypoalbuminaemia was a strong independent prognostic factor for long-term outcomes of death and MACCE. Albumin improved the prediction of death with the SYNTAX score and the SYNTAX II score. Acknowledgement/Funding CAMS Innovation Fund for Medical Sciences (2016-I2M-1-002), Beijing Natural Science Foundation (7181008)

Download Full-text

PROGNOSTIC VALUE OF ANATOMICAL AND CLINICAL SYNTAX SCORE IN VETERANS WITH LEFT MAIN OR THREE-VESSEL CORONARY ARTERY DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)30641-7 ◽

2018 ◽

Vol 71 (11) ◽

pp. A100

Author(s):

Naoki Misumida ◽

Ahmed E. Ahmed ◽

Mariah Pagath ◽

Rachel Goodwin ◽

Elliot Goodwin ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Prognostic Value ◽

Syntax Score ◽

Left Main ◽

Vessel Coronary Artery Disease ◽

Artery Disease ◽

Vessel Coronary Artery

Download Full-text

PM192 Hba1c Modified Clinical Syntax Score As A Prognostic Tool In Patients With Diabetes Mellitus And Multi-Vessel Coronary Artery Disease Treated With Primary Pci

Global Heart ◽

10.1016/j.gheart.2014.03.1579 ◽

2014 ◽

Vol 9 (1) ◽

pp. e102

Author(s):

Natasa M. Milic ◽

Marija Mirkovic ◽

Emilija M. Nestorovic ◽

MIljko R. Ristic ◽

Vesna D. Garovic ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Syntax Score ◽

Primary Pci ◽

Prognostic Tool ◽

Vessel Coronary Artery Disease ◽

Patients With Diabetes ◽

Artery Disease ◽

Vessel Coronary Artery

Download Full-text

Predictive value of in-hospital white blood cell count in Chinese patients with triple-vessel coronary disease

European Journal of Preventive Cardiology ◽

10.1177/2047487319826398 ◽

2019 ◽

Vol 26 (8) ◽

pp. 872-882 ◽

Cited By ~ 4

Author(s):

Xueyan Zhao ◽

Lin Jiang ◽

Lianjun Xu ◽

Jian Tian ◽

Yujun Xu ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Blood Cell ◽

White Blood Cell ◽

Predictive Value ◽

Hazard Ratio ◽

Syntax Score ◽

Vessel Coronary Artery Disease ◽

Artery Disease ◽

Vessel Coronary Artery

Aims The predictive value of white blood cells in triple-vessel coronary artery disease (TVD) remains unclear. This study aimed to examine the relationship between WBC counts and long-term prognosis of TVD. Methods A total of 8943 consecutive patients with triple-vessel coronary artery disease were enrolled from April 2004 to February 2011. The primary endpoint was all-cause death and the secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs; a composite of all-cause death, myocardial infarction or stroke). Results After a median of 7.5 years of follow-up, 7678 patients were included in the final analysis. Multivariable analysis showed that the white blood cell count was an independent predictor of death (hazard ratio: 1.04, p < 0.01) and MACCE (hazard ratio: 1.03, p = 0.02). In white blood cell differential analysis, increased monocytes (hazard ratio: 1.93, p = 0.001) and eosinophils (hazard ratio: 1.82, p < 0.01), and decreased lymphocytes (hazard ratio: 0.89, p = 0.02) were independent predictors of death. Increased monocytes (hazard ratio: 1.62, P = 0.002) and eosinophils (hazard ratio: 1.55, p < 0.01) were independent predictors of MACCE. A combination of monocyte, lymphocyte and eosinophil counts with the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score improved the predictive value for mortality (area under the curve from 0.569 to 0.611; integrated discrimination improvement = 0.012; net reclassification improvement = 0.299) and improved slightly with SYNTAX score II (all p < 0.05). Conclusion Total and differential white blood cell counts are independent prognostic factors of long-term mortality and MACCE in triple-vessel coronary artery disease. A combination of monocyte, lymphocyte and eosinophil counts improved the predictive value for mortality with the SYNTAX score, and improved it slightly with SYNTAX score II.

Download Full-text