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The 123s and ABCs of the simplified SYNTAX score
Abstract
S306
453 The 123s and ABCs of the simplified SYNTAX score R. Bing 1,∗ , J. Zhao 1 , S. Papapostolou 2 , S. Burgess 3 , E. Danson 5 , R. Bhindi 5 , S. Lo 3 , W. Chan 2 , M. Ng 4 , L. Kritharides 1 , A. Yong 1 1 Concord Repatriation General Hospital, Sydney, Australia 2 The Alfred Hospital, Melbourne, Australia 3 Liverpool Hospital, Sydney, Australia 4 Royal Prince Alfred Hospital, Sydney, Australia 5 Royal North Shore Hospital, Sydney, Australia
Introduction: The SYNTAX score (SS) is an angiographic tool endorsed by major clinical guidelines that stratifies the complexity of percutaneous coronary intervention (PCI) in patients with three-vessel (TVD) and/or left main (LM) disease. PCI offers favourable outcomes in TVD with a low SS or LM with a low-to-intermediate SS. In practice, however, SS application is limited by complexity and the need for online calculators. We sought to devise a simplified SS that could offer accurate, ‘on-table’ identification of cases whereby PCI may be appropriate. Methods: Coronary segment weighting and lesion characteristics in the SS were scaled down to create the simplified SS (see table). All definitions are as per the original SS. ROC analysis from a single-centre derivation cohort of 100 patients were used to determine optimum cut-offs. The simplified SS was then tested in a validation cohort from three other institutions. Results: A total of 184 cases were included in the validation cohort. Mean SS was 20.2±8 (56.5% low SS, 31% intermediate SS, 12.5% high SS). A simplified SS cut-off of <10 for TVD cases yielded 83.1% sensitivity and 100% specificity (AUC 0.98, p<0.001), and a cut-off of <12 for LM cases yielded 86.5% sensitivity and 100% specificity (AUC 0.97, p<0.001) for predicting SS indicating suitability for PCI. Conclusion: The simplified SS is specific and easily memorised, allowing rapid identification of cases that could proceed to PCI based on current guidelines. http://dx.doi.org/10.1016/j.hlc.2015.06.454 CRUSADE risk category
Cases n(%)
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
454 The CRUSADE score is useful in stratifying risk of major bleeding and death following STEMI PCI S. Atique 1,∗ , C. Schultz 2 , J. Rankin 3 , M. Knuiman 4 , M. Nguyen 3 , M. Newman 5 , D. Cutlip 6 , T. Briffa 4 , M. Hobbs 4 , E. Geelhoed 4 , F. Sanfilippo 4 1 Cardiology
Department, Canberra Hospital, Canberra, ACT, Australia 2 Cardiology Department, Royal Perth Hospital, Perth, WA, Australia 3 Cardiology Department, Fiona Stanley Hospital, Perth, WA, Australia 4 School of Population Health, University of Western Australia, Perth, WA, Australia 5 Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia 6 Harvard Medical School, Boston, USA Introduction: STEMI patients are at increased risk of bleeding related to anticoagulant, antiplatelet and interventional therapies. We determined if the CRUSADE bleeding risk score, developed for NSTEMI, was discriminating in patients with STEMI. Methods: All patients with PCI-treated STEMI admitted to Western Australian public hospitals (98.6% of STEMI PCI) between 2000-2005 were identified. Hospital admissions and mortality data (from WA Data Linkage System) were linked with procedural and transfusion data. The calculated CRUSADE score was stratified into its 5 risk categories. Associations with major bleeding and mortality at 30 days and 1 year were assessed using Cochran-Armitage trend test and logistic regression. Results: 1562 patients were identified with mean age 62 years (range 26-92) and 77% were males. 30-day and 1-year mortality were 3.6% (n=57) and 6.1% (n=95), respectively, whilst major bleeding was 2.8% (n=43) and 3.9% (n=61). There was a significant increasing trend across CRUSADE risk strata for all outcomes (p<0.0001) which persisted after adjusting for age, sex, IIbIIIa use and Charlson comorbidity index.
OR death
OR bleeding
30-day
1-year
30-day
1-year
............................................................................................... very low (<=20)
628 (40.2)
1.0
1.0
1.0
1.0
low (21 to 30)
475 (30.4)
2.0
2.3
0.9
1.0
moderate (31 to 40)
268 (17.2)
5.2
4.1
1.7
1.4
high (41 to 50)
119 (7.6)
13.2
8.0
0.9
1.5
very high (>50)
72 (4.6)
17.4
12.7
5.5
6.6
............................................................................................... p value
<0.0001
<0.0001
0.018
0.0025
S306
453 The 123s and ABCs of the simplified SYNTAX score R. Bing 1,∗ , J. Zhao 1 , S. Papapostolou 2 , S. Burgess 3 , E. Danson 5 , R. Bhindi 5 , S. Lo 3 , W. Chan 2 , M. Ng 4 , L. Kritharides 1 , A. Yong 1 1 Concord Repatriation General Hospital, Sydney, Australia 2 The Alfred Hospital, Melbourne, Australia 3 Liverpool Hospital, Sydney, Australia 4 Royal Prince Alfred Hospital, Sydney, Australia 5 Royal North Shore Hospital, Sydney, Australia
Introduction: The SYNTAX score (SS) is an angiographic tool endorsed by major clinical guidelines that stratifies the complexity of percutaneous coronary intervention (PCI) in patients with three-vessel (TVD) and/or left main (LM) disease. PCI offers favourable outcomes in TVD with a low SS or LM with a low-to-intermediate SS. In practice, however, SS application is limited by complexity and the need for online calculators. We sought to devise a simplified SS that could offer accurate, ‘on-table’ identification of cases whereby PCI may be appropriate. Methods: Coronary segment weighting and lesion characteristics in the SS were scaled down to create the simplified SS (see table). All definitions are as per the original SS. ROC analysis from a single-centre derivation cohort of 100 patients were used to determine optimum cut-offs. The simplified SS was then tested in a validation cohort from three other institutions. Results: A total of 184 cases were included in the validation cohort. Mean SS was 20.2±8 (56.5% low SS, 31% intermediate SS, 12.5% high SS). A simplified SS cut-off of <10 for TVD cases yielded 83.1% sensitivity and 100% specificity (AUC 0.98, p<0.001), and a cut-off of <12 for LM cases yielded 86.5% sensitivity and 100% specificity (AUC 0.97, p<0.001) for predicting SS indicating suitability for PCI. Conclusion: The simplified SS is specific and easily memorised, allowing rapid identification of cases that could proceed to PCI based on current guidelines. http://dx.doi.org/10.1016/j.hlc.2015.06.454 CRUSADE risk category
Cases n(%)
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
454 The CRUSADE score is useful in stratifying risk of major bleeding and death following STEMI PCI S. Atique 1,∗ , C. Schultz 2 , J. Rankin 3 , M. Knuiman 4 , M. Nguyen 3 , M. Newman 5 , D. Cutlip 6 , T. Briffa 4 , M. Hobbs 4 , E. Geelhoed 4 , F. Sanfilippo 4 1 Cardiology
Department, Canberra Hospital, Canberra, ACT, Australia 2 Cardiology Department, Royal Perth Hospital, Perth, WA, Australia 3 Cardiology Department, Fiona Stanley Hospital, Perth, WA, Australia 4 School of Population Health, University of Western Australia, Perth, WA, Australia 5 Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia 6 Harvard Medical School, Boston, USA Introduction: STEMI patients are at increased risk of bleeding related to anticoagulant, antiplatelet and interventional therapies. We determined if the CRUSADE bleeding risk score, developed for NSTEMI, was discriminating in patients with STEMI. Methods: All patients with PCI-treated STEMI admitted to Western Australian public hospitals (98.6% of STEMI PCI) between 2000-2005 were identified. Hospital admissions and mortality data (from WA Data Linkage System) were linked with procedural and transfusion data. The calculated CRUSADE score was stratified into its 5 risk categories. Associations with major bleeding and mortality at 30 days and 1 year were assessed using Cochran-Armitage trend test and logistic regression. Results: 1562 patients were identified with mean age 62 years (range 26-92) and 77% were males. 30-day and 1-year mortality were 3.6% (n=57) and 6.1% (n=95), respectively, whilst major bleeding was 2.8% (n=43) and 3.9% (n=61). There was a significant increasing trend across CRUSADE risk strata for all outcomes (p<0.0001) which persisted after adjusting for age, sex, IIbIIIa use and Charlson comorbidity index.
OR death
OR bleeding
30-day
1-year
30-day
1-year
............................................................................................... very low (<=20)
628 (40.2)
1.0
1.0
1.0
1.0
low (21 to 30)
475 (30.4)
2.0
2.3
0.9
1.0
moderate (31 to 40)
268 (17.2)
5.2
4.1
1.7
1.4
high (41 to 50)
119 (7.6)
13.2
8.0
0.9
1.5
very high (>50)
72 (4.6)
17.4
12.7
5.5
6.6
............................................................................................... p value
<0.0001
<0.0001
0.018
0.0025