Key result
The Global Risk Score was an independent predictor of 1-year major adverse cardiovascular events (HR 5.5) and demonstrated superior discriminatory ability compared to the Clinical SYNTAX Score (AUC 0.891 vs 0.743, P=0.007).
Why the study?
Does the Global Risk Score or Clinical SYNTAX Score better predict 1-year MACE in patients undergoing unprotected left main PCI?
Cohort (n=92)
No
Does the Global Risk Score or Clinical SYNTAX Score better predict 1-year MACE in patients undergoing unprotected left main PCI?
The Global Risk Score demonstrates superior discriminatory ability compared to the Clinical SYNTAX Score in predicting 1-year major adverse cardiovascular events following unprotected left main PCI.
BACKGROUND: Risk stratification is an important component of left main percutaneous catheter intervention (PCI) which has emerged as a feasible alternative to cardiac surgery. We sought to compare the clinical SYNTAX score and the global risk score in predicting outcomes of patients undergoing unprotected left main PCI in our institution. METHODS: Clinical, angiographic and procedural characteristics of 92 patients who underwent unprotected left main PCI (mean age 62 ± 12.1 years) were analyzed. Patients were risk stratified into tertiles of high, intermediate and low risk using the global risk score (GRS) and the clinical SYNTAX score (CSS) and were prospectively followed up at 1 year for the occurrence of major adverse cardiovascular events (MACEs), defined as a composite of all cause mortality, cardiac mortality, non-fatal myocardial infarction, stroke, coronary artery bypass, and target vessel revascularization. RESULTS: There were 26 (28.2%) who experienced MACEs, of which 10 (10.8%) patients died. Multivariable hazards analysis showed that the GRS (hazard ratio (HR) = 5.5, P = 0.001) and CSS (HR = 4.3, P = 0.001) were both independent predictors of MACEs. Kaplan-Meier analysis showed higher incidence of MACEs with the intermediate and higher risk categories compared to those classified as low risk. Receiver-operator characteristic analysis showed that the GRS has better discriminatory ability than the CSS in the prediction of 1 year MACEs (0.891 vs. 0.743, P = 0.007). CONCLUSION: The GRS and CSS are predictive of outcomes after left main PCI. The GRS appears to have superior predictive and prognostic utility compared to the CSS. This study emphasizes the importance of combining both anatomic and clinical variables for optimum prognostication and management decisions in left main PCI.
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Cuenza et al. (2017) conducted a cohort in Unprotected left main coronary artery disease (n=92). Global Risk Score vs. Clinical SYNTAX Score was evaluated on Major adverse cardiovascular events (MACE) at 1 year (HR 5.5, p=0.001). The Global Risk Score was an independent predictor of 1-year major adverse cardiovascular events (HR 5.5) and demonstrated superior discriminatory ability compared to the Clinical SYNTAX Score (AUC 0.891 vs 0.743, P=0.007).
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