TY - JOUR
T1 - Impact of Chronic Total Occlusions on Revascularization Scores and Outcome Prediction
AU - Redfors, Björn
AU - Palmerini, Tullio
AU - Caixeta, Adriano
AU - Ayele, Girma Minalu
AU - Francese, Dominic P.
AU - Mehran, Roxana
AU - Brilakis, Emmanouil S.
AU - Kirtane, Ajay J.
AU - Karmpaliotis, Dimitri
AU - Stone, Gregg W.
AU - Généreux, Philippe
PY - 2017/4
Y1 - 2017/4
N2 - OBJECTIVES: To evaluate the contribution of chronic total occlusion (CTO)-related SYNTAX score (SS) to the overall SS for patients with CTO and compare the traditional SS to a simplified variant. The SS algorithm assigns CTO lesions a greater weight (5× points) than non-CTO lesions (50% to <100% diameter stenosis; 2× points). METHODS: We calculated the SS and the simplified SS (2× points also to CTO lesions) for 4356 patients from the angiographic substudy of the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial. We compared the association between SS and 1-year mortality and major adverse cardiac events for patients with and without a CTO. We also compared the simplified SS with the traditional SS. RESULTS: The median SS was 20 (interquartile range, 13-27.5) for patients with a CTO and 8 (interquartile range, 2-16) for patients without a CTO. For patients with a CTO, the CTO lesion(s) contributed 67 ± 26% of the total SS. The simplified SS reclassified 187/603 (31.0%) of patients with a SS >22 to a SS ≤22. The traditional SS did not improve discrimination indices for predicting outcomes compared with the simplified SS. CONCLUSIONS: CTO lesions contribute considerably to the total SS in patients with a CTO. A simplified SS that does not differentiate between CTO and non-CTO lesions appeared equivalent to the traditional SS for risk prediction, but reclassified a substantial proportion of patients to a SS ≤22 and may impact choice of revascularization strategy for patients with complex coronary artery disease involving a CTO lesion.
AB - OBJECTIVES: To evaluate the contribution of chronic total occlusion (CTO)-related SYNTAX score (SS) to the overall SS for patients with CTO and compare the traditional SS to a simplified variant. The SS algorithm assigns CTO lesions a greater weight (5× points) than non-CTO lesions (50% to <100% diameter stenosis; 2× points). METHODS: We calculated the SS and the simplified SS (2× points also to CTO lesions) for 4356 patients from the angiographic substudy of the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial. We compared the association between SS and 1-year mortality and major adverse cardiac events for patients with and without a CTO. We also compared the simplified SS with the traditional SS. RESULTS: The median SS was 20 (interquartile range, 13-27.5) for patients with a CTO and 8 (interquartile range, 2-16) for patients without a CTO. For patients with a CTO, the CTO lesion(s) contributed 67 ± 26% of the total SS. The simplified SS reclassified 187/603 (31.0%) of patients with a SS >22 to a SS ≤22. The traditional SS did not improve discrimination indices for predicting outcomes compared with the simplified SS. CONCLUSIONS: CTO lesions contribute considerably to the total SS in patients with a CTO. A simplified SS that does not differentiate between CTO and non-CTO lesions appeared equivalent to the traditional SS for risk prediction, but reclassified a substantial proportion of patients to a SS ≤22 and may impact choice of revascularization strategy for patients with complex coronary artery disease involving a CTO lesion.
KW - Non'ST elevation acute coronary syndromes
KW - SYNTAX score
KW - coronary artery bypass grafting
UR - http://www.scopus.com/inward/record.url?scp=85017260215&partnerID=8YFLogxK
M3 - Article
C2 - 28296639
AN - SCOPUS:85017260215
SN - 1042-3931
VL - 29
SP - 123
EP - 131
JO - Journal of Invasive Cardiology
JF - Journal of Invasive Cardiology
IS - 4
ER -