Key result
Clinical SYNTAX score outperforms anatomical score for predicting new-onset AF with ~0.72 AUC.
Why the study?
New-onset atrial fibrillation is a frequent complication in NSTEMI patients and early identification of predictors is essential for risk stratification and management.
Does the Clinical SYNTAX score predict new-onset atrial fibrillation and long-term outcomes better than anatomical SYNTAX, GRACE, and CHA2DS2-VASc scores in NSTEMI patients undergoing coronary angiography?
Cohort (n=979)
Does the Clinical SYNTAX score predict new-onset atrial fibrillation and long-term outcomes better than anatomical SYNTAX, GRACE, and CHA2DS2-VASc scores in NSTEMI patients undergoing coronary angiography?
Effect estimate: AUC 0.724 (95% CI 0.673-0.775)
p-value: p=<0.001
The Clinical SYNTAX score independently predicts new-onset atrial fibrillation and long-term adverse outcomes in NSTEMI patients, outperforming the anatomical SYNTAX score.
Clinical SYNTAX score may aid NOAF risk stratification in NSTEMI; hypothesis-generating and requires prospective validation before practice change.
New-onset atrial fibrillation (NOAF) is a frequent complication among patients with non-ST-elevation myocardial infarction (NSTEMI) and is associated with adverse outcomes, making early identification of predictors essential for risk stratification and management. This retrospective cohort study evaluated the prognostic value of the Clinical SYNTAX score (CSS) compared with the anatomical SYNTAX score (SS), GRACE, and CHA2DS2-VASc scores in predicting in-hospital NOAF and long-term outcomes among 979 NSTEMI patients undergoing coronary angiography. Predictors of NOAF, all-cause mortality, and major adverse cardiovascular events (MACEs: death, myocardial infarction, stroke) were identified using logistic and Cox regression models, with receiver operating characteristic (ROC) analysis used to compare the discriminative power of CSS against SS, GRACE, and CHA2DS2-VASc over a median follow-up of 86 months (IQR 36–100; range 0.1–144). NOAF developed in 80 patients (8.2%), with age, female gender, left atrial diameter, left ventricular diastolic dysfunction, and CSS (p = 0.014) identified as independent predictors. CSS’s AUC for predicting NOAF (0.724; 95% CI: 0.673–0.775) was significantly higher than SS’s (0.644; 95% CI: 0.588–0.699; DeLong p < 0.001) and comparable to that of the CHA2DS2-VASc and GRACE scores; a CSS threshold ≥ 17.77 predicted NOAF with 75% sensitivity and 65% specificity. In Cox regression analysis, in-hospital NOAF, age, hypertension, reduced ejection fraction (<60%), and CSS independently predicted long-term all-cause mortality, while NOAF, EF < 60%, age, early AF recurrence, hypertension, and CSS independently predicted MACEs; SS was not a significant predictor in either model. In non-overlapping multivariable models, this advantage reflected the contribution of CSS’s clinical components rather than incremental value of the composite score; CSS nonetheless remained an independent predictor of NOAF and long-term outcomes and may serve as a practical single-score tool for risk-guided management.
No takes yet. Share an insight, caveat, or question.
Bulat et al. (2026) conducted a cohort in Non-ST-elevation myocardial infarction (NSTEMI) (n=979). Clinical SYNTAX score (CSS) vs. Anatomical SYNTAX score (SS), GRACE, and CHA2DS2-VASc scores was evaluated on In-hospital new-onset atrial fibrillation (NOAF) (AUC 0.724, 95% CI 0.673-0.775, p=<0.001). The Clinical SYNTAX score predicted new-onset atrial fibrillation with an AUC of 0.724 (95% CI 0.673-0.775), significantly outperforming the anatomical SYNTAX score (AUC 0.644; P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: