Risk stratification in non-ST elevation acute coronary syndromes: searching for the right formula
Key result
A SYNTAX score >8 was reported to predict 1-year MACE (83 events) and mortality (34 deaths) in 1,275 medically managed NSTE ACS patients, though this editorial questions the finding's robustness.
Why the study?
Does the SYNTAX score accurately predict 1-year MACE and mortality in medically managed NSTE ACS patients?
Population
1275 medically managed non-ST elevation acute coronary syndrome patients, nearly 50% women.
Comparison
Risk stratification using SYNTAX score (SS > 8) vs SYNTAX score ≤ 8 or no CAD (SS = 0)
Design
Editorial
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
This editorial cautions against relying solely on the SYNTAX score for risk stratification in medically managed NSTE ACS patients, advocating for established clinical scores like GRACE and continued optimal medical therapy regardless of angiographic CAD severity.
Structured PICO
Does the SYNTAX score accurately predict 1-year MACE and mortality in medically managed NSTE ACS patients?
P
Population
1,275 medically managed NSTE ACS patients (nearly 50% women) from the ACUITY trial, evaluated for the prognostic utility of the SYNTAX score at 1 year.
E
Exposure
Risk stratification using SYNTAX score (SS > 8)
C
Comparator
SYNTAX score ≤ 8 or no CAD (SS = 0)
O
Outcome
1-year major adverse cardiac events (MACE; mortality, myocardial infarction, and unplanned revascularization) and all-cause mortalitycomposite
This editorial cautions against relying solely on the SYNTAX score for risk stratification in medically managed NSTE ACS patients, advocating for established clinical scores like GRACE and continued optimal medical therapy regardless of angiographic CAD severity.
Limitations
- The analyzed cohort constitutes a low-risk 28% subset of the overall medically managed ACUITY population
- Low sensitivities, specificities, and areas under the ROC curves for the SYNTAX score
- Patients were recruited ~10 years ago, limiting applicability to contemporary practice
- Only a minority of patients received optimal medical therapy
- Low risk subset with small number of events
- Older data (ACUITY recruited ~10 years ago)
- Did not use validated GRACE scores for adjustment
- Potential harm of withholding optimal medical therapy in SS=0 patients
Cite This Study
Shavadia et al. (2015) conducted an editorial in Non-ST elevation acute coronary syndromes (NSTE ACS) (n=1,275). SYNTAX score >8 vs. SYNTAX score ≤8 or 0 was evaluated on Major adverse cardiac events (MACE) and all-cause mortality at 1 year. A SYNTAX score >8 was reported to predict 1-year MACE (83 events) and mortality (34 deaths) in 1,275 medically managed NSTE ACS patients, though this editorial questions the finding's robustness.