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Capodanno, Davide; Giacoppo, Daniele; Dipasqua, Fabio; Miccichè, Eligio; Licitra, Carmelo; Di Salvo, Maria Elena; Francaviglia, Bruno; Grasso, Carmelo; La Manna, Alessio; Sgroi, Carmelo; Tamburino, Corrado

Usefulness of the logistic clinical SYNTAX score for predicting 1‐year mortality in patients undergoing percutaneous coronary intervention of the left main coronary artery

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  • Media type: E-Article
  • Title: Usefulness of the logistic clinical SYNTAX score for predicting 1‐year mortality in patients undergoing percutaneous coronary intervention of the left main coronary artery
  • Contributor: Capodanno, Davide; Giacoppo, Daniele; Dipasqua, Fabio; Miccichè, Eligio; Licitra, Carmelo; Di Salvo, Maria Elena; Francaviglia, Bruno; Grasso, Carmelo; La Manna, Alessio; Sgroi, Carmelo; Tamburino, Corrado
  • Published: Wiley, 2013
  • Published in: Catheterization and Cardiovascular Interventions, 82 (2013) 4
  • Language: English
  • DOI: 10.1002/ccd.24944
  • ISSN: 1522-1946; 1522-726X
  • Origination:
  • Footnote:
  • Description: ObjectivesTo externally validate the logistic clinical SYNTAX in patients undergoing percutaneous coronary intervention (PCI) of the left main coronary artery (LMCA).BackgroundA novel version of the clinical SYNTAX score (CSS) has been recently introduced to overcome the limitations of categorical risk scores for PCI by the incorporation of clinical variables and the SYNTAX score (SXscore) into a logistic formula for predicting 1‐year mortality.MethodsCore and extended models of the logistic CSS (logCSScore and logCSSext) were applied to 400 patients undergoing LMCA PCI, and their performance was compared with those of the standard CSS, SXscore, and age, creatinine, and ejection fraction (ACEF) score by different measures of discrimination and calibration.ResultsA significant gradient in the distribution of 1‐year mortality was noted with all the models (P < 0.001), with the SYNTAX and ACEF scores showing the lowest (0.64) and the highest (0.75) c‐statistic, respectively. Based on Somers' Dxy rank correlation, discrimination of both the logCSScore and the logCSSext was numerically lower than that of the ACEF score. The logCSScore was miscalibrated toward underpredicting all‐cause mortality in low‐predicted probabilities, while the logCSSext tended to underpredict in low‐predicted probabilities and overpredict in high‐predicted probabilities. Slope and intercept values reflected a better calibration ability of the logCSScore compared with the logCSSext. The global accuracy of the logCSScore was superior to that of the logCSSext (Brier score 0.087 vs. 0.095).ConclusionsA personalized approach to risk stratification of LMCA PCI with the logistic CSS is feasible and of potential clinical utility. However, in this study, the logistic CSS did not achieve superior discrimination compared with other categorical models, and suffered from mild to moderate miscalibration. © 2013 Wiley Periodicals, Inc.