Validation of the updated logistic clinical SYNTAX score for all-cause mortality in the GLOBAL LEADERS trial

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Chichareon, Ply ^{[1, 2]} ; Onuma, Yoshinobu ^[3] ; Van Klaveren, David ^[4] ; Modolo, Rodrigo ^{[1, 5]} ; Kogame, Norihiro ^[1] ; Takahashi, Kuniaki ^[1] ; Chang, Chun Chin ^[3] ; Tomaniak, Mariusz ^{[3, 6]} ; Asano, Taku ^[1] ; Katagiri, Yuki ^[1] ; Van Geuns, Robert-Jan ^[7] ; Bolognese, Leonardo ^[8] ; Tumscitz, Carlo ^[9] ; Vrolix, Mathias ^[10] ; Petrov, Ivo ^[11] ; Garg, Scot ^[12] ; Naber, Christoph Kurt ^[13] ; Sabate, Manel ^{[14, 15]} ; Iqbal, Javaid ^[16] ; Wykrzykowska, Joanna J. ^[1] ; Piek, Jan J. ^[1] ; Spitzer, Ernest ^{[17, 3]} ; Juni, Peter ^[18] ; Hamm, Christian W. ^[19] ; Steg, Gabriel ^{[20, 21, 22]} ; Valgimigli, Marco ^[23] ; Vranckx, Pascal ^[24] ; Windecker, Stephan ^[23] ; Serruys, Patrick W. ^[25]

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^[1] Univ Amsterdam, Ctr Heart, Dept Clin & Expt Cardiol, Amsterdam Cardiovasc Sci, Amsterdam UMC, Amsterdam - Netherlands

^[2] Prince Songkla Univ, Cardiol Unit, Dept Internal Med, Fac Med, Hat Yai - Thailand

^[3] Erasmus Univ, Erasmus Med Ctr, Rotterdam - Netherlands

^[4] Leiden Univ, Dept Biomed Data Sci, Med Ctr, Leiden - Netherlands

^[5] Univ Campinas UNICAMP, Div Cardiol, Dept Internal Med, Campinas, SP - Brazil

^[6] Med Univ Warsaw, Dept Cardiol 1, Warsaw - Poland

^[7] Erasmus MC, Dept Cardiol, Rotterdam - Netherlands

^[8] San Donato Hosp, Cardiovasc Dept, Arezzo - Italy

^[9] Azienda Osped Univ Ferrara, Cardiol Unit, Cona - Italy

^[10] Oost Limburg Hosp, Genk - Belgium

^[11] Acibadem City Clin, Cardiovasc Ctr, Sofia - Bulgaria

^[12] East Lancashire Hosp NHS Trust, Blackburn, Lancs - England

^[13] Elisabeth Krankenhaus Essen, Contilia Heart & Vasc Ctr, Essen - Germany

^[14] Hosp Clin Barcelona, Thorax Inst, Dept Cardiol, Barcelona - Spain

^[15] Univ Barcelona, IDIBAPS, Barcelona - Spain

^[16] Sheffield Teaching Hosp NHS Fdn Trust, South Yorkshire Cardiothorac Ctr, Northern Gen Hosp, Sheffield, S Yorkshire - England

^[17] Cardialysis Clin Trials Management & Core Labs, Rotterdam - Netherlands

^[18] Univ Toronto, Li Ka Shing Knowledge Inst, St Michaels Hosp, Appl Hlth Res Ctr, Toronto, ON - Canada

^[19] Campus Univ Giessen, Kerckhoff Heart Ctr, Bad Nauheim - Germany

^[20] Univ Paris Diderot, FACT, Hop Bichat, APHP, Paris - France

^[21] INSERM, U1148, Paris - France

^[22] Imperial Coll London, Royal Brompton Hosp, London - England

^[23] Bern Univ Hosp, Dept Cardiol, Bern - Switzerland

^[24] Jessa Ziekenhuis, Hartctr Hasselt, Dept Cardiol & Crit Care Med, Hasselt - Belgium

^[25] Imperial Coll London, NHLI, London - England

• Tipo de documento: Artigo Científico
• Fonte: EUROINTERVENTION; v. 15, n. 6, p. E539+, AUG 2019.
• Citações Web of Science: 0

Resumo

Aims: The aim of this study was the external validation of the updated logistic clinical SYNTAX score for two-year all-cause mortality after PCI in the GLOBAL LEADERS trial. Methods and results: The GLOBAL LEADERS trial was an investigator-initiated, prospective randomised, multicentre, open-label trial comparing two strategies of antiplatelet therapy in 15,991 patients undergoing PCI. As a predefined analysis, we studied the first 4,006 consecutive patients enrolled between July 2013 and April 2014 for whom the anatomic SYNTAX scores were calculated by an independent core lab. The updated logistic clinical SYNTAX score was available in 3,271 patients. Patients were divided into quintiles according to the score. The C-statistic of the updated logistic clinical SYNTAX score for two-year all-cause mortality was 0.71 (95% confidence interval {[}CI]: 0.64-0.77). The updated logistic clinical SYNTAX score identified patients at very high risk for two-year all-cause mortality after PCI. Although it systematically overestimated two-year all-cause mortality, predicted and observed two-year all-cause mortality in the majority of the patients (four out of five quintiles) were in agreement. Conclusions: Overall discrimination for two-year all-cause mortality of the updated logistic clinical SYNTAX score is either borderline acceptable or possibly helpful. Calibration in the majority of patients is appropriate. The score is potentially useful in selecting enriched high-risk populations. (AU)

• Processo FAPESP: 17/22013-8 - Impacto da complexidade coronariana sobre a mortalidade e eventos cardiovasculares de pacientes com infarto agudo do miocárdio em diferentes regimes de tratamento antiplaquetário
• Beneficiário: Rodrigo Gimenez Pissutti Modolo
• Modalidade de apoio: Bolsas no Exterior - Pesquisa