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Incremental prognostic value of the SYNTAX score to late gadolinium-enhanced magnetic resonance images for patients with stable coronary artery disease

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Abstract

The prognostic significance of the SYNTAX (Synergy between PCI with Taxus and cardiac surgery) score has recently been demonstrated in patients with stable multivessel or left main coronary artery disease (CAD). The present study determines whether adding the SYNTAX score to Framingham risk score (FRS), left ventricular ejection fraction (LVEF) and presence of myocardial infarction (MI) by late gadolinium enhancement (LGE) magnetic resonance imaging can improve the risk stratification in patients with stable CAD. We calculated the SYNTAX score in 161 patients with stable CAD (mean age: 66 ± 10 years old). During a mean follow-up of 2.3 years, 56 (35 %) of 161 patients developed cardiovascular events defined as cardiovascular death, non-fatal MI, cerebral infarction, unstable angina pectoris, hospitalization due to heart failure and revascularization. Multivariate Cox regression analysis selected triglycerides [hazard ratio (HR): 1.005 (95 % confidence interval (CI): 1.001–1.008), p < 0.008], presence of LGE [HR: 6.329 (95 % CI: 2.662–15.05), p < 0.001] and the SYNTAX score [HR: 1.085 (95 % CI: 1.044–1.127), p < 0.001] as risk factors for future cardiovascular events. Adding the SYNTAX score to FRS, EF and LGE significantly improved the net reclassification index (NRI) [40.4 % (95 % CI: 18.1–54.8 %), p < 0.05] with an increase in C-statistics of 0.089 (from 0.707 to 0.796). An increase in C-statistics and significant improvement of NRI showed that adding the SYNTAX score to the FRS, LVEF and LGE incrementally improved risk stratification in patient with stable CAD.

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Acknowledgments

We are grateful to Hiroshi Hayashi, RT and Yukihiro Ishii, RT (Department of Radiology, Kanagawa Cardiovascular and Respiratory Center) for their technical assistance.

Conflict of interest

There are no conflicts of interest to declare.

Disclosure

Shingo Kato, MD, PhD: Scholarship from Banyu Life Science Foundation International. Satoshi Umemura, MD, PhD: Research support or honoraria or both from Astellas Pharm Inc., AstraZeneca K.K., Bayer Yakuhin, Ltd., Boehringer Ingelheim Japan, Inc., Chugai Pharmaceutical Co., Ltd., Daiichi-Sankyou Company, Limited, Dainippon Sumitimo Pharma Co., Ltd., Kowa Company, Ltd., MSD K.K., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Sanofi K.K., Takeda Pharmaceutical Company,, Torii Pharmaceutical Co.,Ltd., Shionogi & Co. Ltd., Kyouwa-Hakkou-Kirin Co. Ltd.,, Mochida Pharmaceutical Co. Ltd.,, Mitsubishi Tanabe Pharma Corporation, Teijin Pharma Ltd.,, Acterion Pharmaceuticals Japan Ltd., Sanwa-Kagaku Kenkyusho Co. Ltd.

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Authors and Affiliations

  1. Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan

    Shingo Kato, Naka Saito, Hidekuni Kirigaya, Daiki Gyotoku, Naoki Iinuma, Yuka Kusakawa, Kohei Iguchi, Tatsuya Nakachi & Kazuki Fukui

  2. Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan

    Masaaki Futaki & Tae Iwasawa

  3. Department of Biostatistics and Epidemiology, Yokohama City University, Yokohama, Japan

    Masataka Taguri

  4. Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan

    Kazuo Kimura

  5. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Hospital, Yokohama, Japan

    Satoshi Umemura

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  1. Shingo Kato
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  2. Naka Saito
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  3. Hidekuni Kirigaya
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  4. Daiki Gyotoku
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  5. Naoki Iinuma
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  9. Kazuki Fukui
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  13. Kazuo Kimura
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  14. Satoshi Umemura
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Correspondence to Shingo Kato.

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Kato, S., Saito, N., Kirigaya, H. et al. Incremental prognostic value of the SYNTAX score to late gadolinium-enhanced magnetic resonance images for patients with stable coronary artery disease. Heart Vessels 31, 871–880 (2016). https://doi.org/10.1007/s00380-015-0685-x

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