CSS, NERS, SYNTAX best risk scores for predicting coronary prognosis
MedWire News: Risk scores incorporating clinical and angiographic variables provide the highest predictive accuracy in patients with NSTE-ACS undergoing percutaneous coronary intervention (PCI), suggest study findings.
Current guidelines for the management of patients with NSTE-ACS (non-ST-segment elevation acute coronary syndromes) recommend the use of the Thrombolysis in Myocardial Infarction (TIMI) risk score or the Global Registry for Acute Coronary Events (GRACE) score for risk stratification of patients with NSTE-ACS.
"These scores were not intended specifically for patients undergoing an early invasive strategy with PCI and do not include angiographic variables, which may contribute independent prognostic information," say Gregg Stone (Columbia University, New York, USA) and colleagues.
The team therefore investigated the accuracy of six scores for assessment of 1-year mortality, cardiac mortality, MI, target vessel revascularization, and stent thrombosis in 2094 patients with NSTE-ACS who received PCI in the angiographic substudy of the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial.
Studied scores included the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) score; Clinical Synergy Between PCI with Taxus and Cardiac Surgery score (CSS); New Risk Stratification (NERS) score; Age, Creatinine, Ejection Fraction (ACEF) score; GRACE score; and TIMI score.
At the end of 1-year follow-up, there were 48 deaths (2.4%), 30 cardiac deaths (1.5%), 198 MIs (9.6%), 157 target vessel revascularizations (8.0%), and 29 episodes of stent thrombosis (1.4%).
Assessment of prognostic accuracy showed that scores incorporating clinical and angiographic variables - such as the CSS and NERS - showed the best trade-off between discrimination and calibration for all studied endpoints. The CSS, NERS, and SYNTAX were the only scores to have both good discrimination and good calibration for cardiac mortality.
The CSS was found to have the best index of separation for most ischemic endpoints and displayed a net reclassification improvement (NRI) for cardiac death and MI compared with other scores. Conversely, the NERS displayed an NRI for all-cause death and target vessel revascularization.
"Risk scores incorporating clinical and angiographic variables [have] the highest predictive accuracy for a broad spectrum of ischemic end points," conclude the researchers in the American Heart Journal.
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By Ingrid Grasmo