The MI SYNTAX score for risk stratification in patients undergoing primary percutaneous coronary intervention for treatment of acute myocardial infarction: A substudy of the COMFORTABLE AMI trial

Michael Magro; Lorenz Räber; Dik Heg; Masanori Taniwaki; Henning Kelbaek; Miodrag Ostojić; Andreas Baumbach; David Tüller; Clemens Von Birgelen; Marco Roffi; Giovanni Pedrazzini; Ran Kornowski; Klaus Weber; Bernhard Meier; Thomas F. Lüscher; Patrick W. Serruys; Peter Jüni; Stephan Windecker

doi:10.1016/j.ijcard.2014.05.029

The MI SYNTAX score for risk stratification in patients undergoing primary percutaneous coronary intervention for treatment of acute myocardial infarction: A substudy of the COMFORTABLE AMI trial

Michael Magro
, Lorenz Räber
, Dik Heg
, Masanori Taniwaki
, Henning Kelbaek
, Miodrag Ostojić
, Andreas Baumbach
, David Tüller
, Clemens Von Birgelen
, Marco Roffi
, Giovanni Pedrazzini
, Ran Kornowski
, Klaus Weber
, Bernhard Meier
, Thomas F. Lüscher
, Patrick W. Serruys
, Peter Jüni
, Stephan Windecker^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

Background To investigate the performance of the MI Sxscore in a multicentre randomised trial of patients undergoing primary percutaneous coronary intervention (PPCI). Methods and results The MI Sxscore was prospectively determined among 1132 STEMI patients enrolled into the COMFORTABLE AMI trial, which randomised patients to treatment with bare-metal (BMS) or biolimus-eluting (BES) stents. Patient- (death, myocardial infarction, any revascularisation) and device-oriented (cardiac death, target-vessel MI, target lesion revascularisation) major adverse cardiac events (MACEs) were compared across MI Sxscore tertiles and according to stent type. The median MI SXscore was 14 (IQR: 9-21). Patients were divided into tertiles of Sxscore_low (≤ 10), Sxscore_intermediate (11-18) and Sxscore _intermediate (≥ 19). At 1 year, patient-oriented MACE occurred in 15% of the Sxscore_intermediate, 9% of the Sxscore _intermediate and 5% of the Sxscore_intermediate tertiles (p < 0.001), whereas device-oriented MACE occurred in 8% of the Sxscore _intermediate, 6% of the Sxscore_intermediate and 4% of the Sxscore_intermediate tertiles (p = 0.03). Addition of the MI Sxscore to the TIMI risk score improved prediction of patient- (c-statistic value increase from 0.63 to 0.69) and device-oriented MACEs (c-statistic value increase from 0.65 to 0.70). Differences in the risk for device-oriented MACE between BMS and BES were evident among Sxscore_intermediate (13% vs. 4% HR 0.33 (0.15-0.74), p = 0.007 rather than those in Sxscore _intermediate: 4% vs. 3% HR 0.68 (0.24-1.97), p = 0.48) tertiles. Conclusions The MI Sxscore allows risk stratification of patient- and device-oriented MACEs among patients undergoing PPCI. The addition of the MI Sxscore to the TIMI risk score is of incremental prognostic value among patients undergoing PPCI for treatment of STEMI.

Original language	English
Pages (from-to)	314-322
Number of pages	9
Journal	International Journal of Cardiology
Volume	175
Issue number	2
DOIs	https://doi.org/10.1016/j.ijcard.2014.05.029
Publication status	Published - 1 Aug 2014
Externally published	Yes

Funding

Dr. Baumbach reported being on advisory boards and receiving consultancy fees from Boston Scientific, Medicines Company, and Abbott Vascular; and receiving payment for lectures from Medicines Company and Japan Stent Inc. Dr. Tüller reported receiving travel expenses from Biotronik, Biosensors, Terumo, and Medtronic. Dr. von Birgelen reported board memberships and receiving lecture fees from Abbott Vascular, Medtronic, and Boston Scientific; receiving consultancy fees from Medtronic; unpaid consultancies from Abbott Vascular, Boston Scientific, Biosensors, Biotronik, and Cordis; receiving grants from Abbott Vascular, Boston Scientific, Biosensors, Biotronik, Cordis, Medtronic, and St. Jude Medical; payment for lectures from Abbott Vascular, Boston Scientific, Medtronic, and MSD; and receiving payment for development of educational presentations from Cordis. Dr. Roffi reported receiving grants from Boston Scientific, Abbott Vascular, Medtronic, and Biosensors; and payment for lectures from Lilly-Daiichy Sankyo. Dr. Lüscher reported receiving research grants for the institution from Abbott, Biosensors, Biotronik, Boston Scientific, and Medtronic, and consultant payments from AstraZeneca, Boehringer Ingelheim, Bayer, Merck, and Pfizer. Dr. Meier reported receiving research contracts for the institution from Abbott, Boston Scientific, Biosensors, and Cordis. Dr. Jüni is an unpaid steering committee or statistical executive committee member of trials funded by Abbott Vascular, Biosensors, Medtronic, and St. Jude Medical. Dr. Windecker reported receiving research contracts for the institution from Abbott, Boston Scientific, Biosensors, Biotronik, Cordis, Medtronic, and St. Jude Medical. All other authors reported no conflicts of interest.

Keywords

Primary percutaneous coronary intervention
ST segment elevation myocardial infarction
SYNTAX score

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10.1016/j.ijcard.2014.05.029

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Magro, M., Räber, L., Heg, D., Taniwaki, M., Kelbaek, H., Ostojić, M., Baumbach, A., Tüller, D., Von Birgelen, C., Roffi, M., Pedrazzini, G., Kornowski, R., Weber, K., Meier, B., Lüscher, T. F., Serruys, P. W., Jüni, P., & Windecker, S. (2014). The MI SYNTAX score for risk stratification in patients undergoing primary percutaneous coronary intervention for treatment of acute myocardial infarction: A substudy of the COMFORTABLE AMI trial. International Journal of Cardiology, 175(2), 314-322. https://doi.org/10.1016/j.ijcard.2014.05.029

@article{cfe490a61f6b4618b118f3195d4c7ff3,

title = "The MI SYNTAX score for risk stratification in patients undergoing primary percutaneous coronary intervention for treatment of acute myocardial infarction: A substudy of the COMFORTABLE AMI trial",

abstract = "Background To investigate the performance of the MI Sxscore in a multicentre randomised trial of patients undergoing primary percutaneous coronary intervention (PPCI). Methods and results The MI Sxscore was prospectively determined among 1132 STEMI patients enrolled into the COMFORTABLE AMI trial, which randomised patients to treatment with bare-metal (BMS) or biolimus-eluting (BES) stents. Patient- (death, myocardial infarction, any revascularisation) and device-oriented (cardiac death, target-vessel MI, target lesion revascularisation) major adverse cardiac events (MACEs) were compared across MI Sxscore tertiles and according to stent type. The median MI SXscore was 14 (IQR: 9-21). Patients were divided into tertiles of Sxscorelow (≤ 10), Sxscoreintermediate (11-18) and Sxscore intermediate (≥ 19). At 1 year, patient-oriented MACE occurred in 15\% of the Sxscoreintermediate, 9\% of the Sxscore intermediate and 5\% of the Sxscoreintermediate tertiles (p < 0.001), whereas device-oriented MACE occurred in 8\% of the Sxscore intermediate, 6\% of the Sxscoreintermediate and 4\% of the Sxscoreintermediate tertiles (p = 0.03). Addition of the MI Sxscore to the TIMI risk score improved prediction of patient- (c-statistic value increase from 0.63 to 0.69) and device-oriented MACEs (c-statistic value increase from 0.65 to 0.70). Differences in the risk for device-oriented MACE between BMS and BES were evident among Sxscoreintermediate (13\% vs. 4\% HR 0.33 (0.15-0.74), p = 0.007 rather than those in Sxscore intermediate: 4\% vs. 3\% HR 0.68 (0.24-1.97), p = 0.48) tertiles. Conclusions The MI Sxscore allows risk stratification of patient- and device-oriented MACEs among patients undergoing PPCI. The addition of the MI Sxscore to the TIMI risk score is of incremental prognostic value among patients undergoing PPCI for treatment of STEMI.",

keywords = "Primary percutaneous coronary intervention, ST segment elevation myocardial infarction, SYNTAX score",

author = "Michael Magro and Lorenz R{\"a}ber and Dik Heg and Masanori Taniwaki and Henning Kelbaek and Miodrag Ostoji{\'c} and Andreas Baumbach and David T{\"u}ller and \{Von Birgelen\}, Clemens and Marco Roffi and Giovanni Pedrazzini and Ran Kornowski and Klaus Weber and Bernhard Meier and L{\"u}scher, \{Thomas F.\} and Serruys, \{Patrick W.\} and Peter J{\"u}ni and Stephan Windecker",

year = "2014",

month = aug,

day = "1",

doi = "10.1016/j.ijcard.2014.05.029",

language = "English",

volume = "175",

pages = "314--322",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

number = "2",

}

Magro, M, Räber, L, Heg, D, Taniwaki, M, Kelbaek, H, Ostojić, M, Baumbach, A, Tüller, D, Von Birgelen, C, Roffi, M, Pedrazzini, G, Kornowski, R, Weber, K, Meier, B, Lüscher, TF, Serruys, PW, Jüni, P & Windecker, S 2014, 'The MI SYNTAX score for risk stratification in patients undergoing primary percutaneous coronary intervention for treatment of acute myocardial infarction: A substudy of the COMFORTABLE AMI trial', International Journal of Cardiology, vol. 175, no. 2, pp. 314-322. https://doi.org/10.1016/j.ijcard.2014.05.029

The MI SYNTAX score for risk stratification in patients undergoing primary percutaneous coronary intervention for treatment of acute myocardial infarction: A substudy of the COMFORTABLE AMI trial. / Magro, Michael; Räber, Lorenz; Heg, Dik et al.
In: International Journal of Cardiology, Vol. 175, No. 2, 01.08.2014, p. 314-322.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - The MI SYNTAX score for risk stratification in patients undergoing primary percutaneous coronary intervention for treatment of acute myocardial infarction

T2 - A substudy of the COMFORTABLE AMI trial

AU - Magro, Michael

AU - Räber, Lorenz

AU - Heg, Dik

AU - Taniwaki, Masanori

AU - Kelbaek, Henning

AU - Ostojić, Miodrag

AU - Baumbach, Andreas

AU - Tüller, David

AU - Von Birgelen, Clemens

AU - Roffi, Marco

AU - Pedrazzini, Giovanni

AU - Kornowski, Ran

AU - Weber, Klaus

AU - Meier, Bernhard

AU - Lüscher, Thomas F.

AU - Serruys, Patrick W.

AU - Jüni, Peter

AU - Windecker, Stephan

PY - 2014/8/1

Y1 - 2014/8/1

N2 - Background To investigate the performance of the MI Sxscore in a multicentre randomised trial of patients undergoing primary percutaneous coronary intervention (PPCI). Methods and results The MI Sxscore was prospectively determined among 1132 STEMI patients enrolled into the COMFORTABLE AMI trial, which randomised patients to treatment with bare-metal (BMS) or biolimus-eluting (BES) stents. Patient- (death, myocardial infarction, any revascularisation) and device-oriented (cardiac death, target-vessel MI, target lesion revascularisation) major adverse cardiac events (MACEs) were compared across MI Sxscore tertiles and according to stent type. The median MI SXscore was 14 (IQR: 9-21). Patients were divided into tertiles of Sxscorelow (≤ 10), Sxscoreintermediate (11-18) and Sxscore intermediate (≥ 19). At 1 year, patient-oriented MACE occurred in 15% of the Sxscoreintermediate, 9% of the Sxscore intermediate and 5% of the Sxscoreintermediate tertiles (p < 0.001), whereas device-oriented MACE occurred in 8% of the Sxscore intermediate, 6% of the Sxscoreintermediate and 4% of the Sxscoreintermediate tertiles (p = 0.03). Addition of the MI Sxscore to the TIMI risk score improved prediction of patient- (c-statistic value increase from 0.63 to 0.69) and device-oriented MACEs (c-statistic value increase from 0.65 to 0.70). Differences in the risk for device-oriented MACE between BMS and BES were evident among Sxscoreintermediate (13% vs. 4% HR 0.33 (0.15-0.74), p = 0.007 rather than those in Sxscore intermediate: 4% vs. 3% HR 0.68 (0.24-1.97), p = 0.48) tertiles. Conclusions The MI Sxscore allows risk stratification of patient- and device-oriented MACEs among patients undergoing PPCI. The addition of the MI Sxscore to the TIMI risk score is of incremental prognostic value among patients undergoing PPCI for treatment of STEMI.

AB - Background To investigate the performance of the MI Sxscore in a multicentre randomised trial of patients undergoing primary percutaneous coronary intervention (PPCI). Methods and results The MI Sxscore was prospectively determined among 1132 STEMI patients enrolled into the COMFORTABLE AMI trial, which randomised patients to treatment with bare-metal (BMS) or biolimus-eluting (BES) stents. Patient- (death, myocardial infarction, any revascularisation) and device-oriented (cardiac death, target-vessel MI, target lesion revascularisation) major adverse cardiac events (MACEs) were compared across MI Sxscore tertiles and according to stent type. The median MI SXscore was 14 (IQR: 9-21). Patients were divided into tertiles of Sxscorelow (≤ 10), Sxscoreintermediate (11-18) and Sxscore intermediate (≥ 19). At 1 year, patient-oriented MACE occurred in 15% of the Sxscoreintermediate, 9% of the Sxscore intermediate and 5% of the Sxscoreintermediate tertiles (p < 0.001), whereas device-oriented MACE occurred in 8% of the Sxscore intermediate, 6% of the Sxscoreintermediate and 4% of the Sxscoreintermediate tertiles (p = 0.03). Addition of the MI Sxscore to the TIMI risk score improved prediction of patient- (c-statistic value increase from 0.63 to 0.69) and device-oriented MACEs (c-statistic value increase from 0.65 to 0.70). Differences in the risk for device-oriented MACE between BMS and BES were evident among Sxscoreintermediate (13% vs. 4% HR 0.33 (0.15-0.74), p = 0.007 rather than those in Sxscore intermediate: 4% vs. 3% HR 0.68 (0.24-1.97), p = 0.48) tertiles. Conclusions The MI Sxscore allows risk stratification of patient- and device-oriented MACEs among patients undergoing PPCI. The addition of the MI Sxscore to the TIMI risk score is of incremental prognostic value among patients undergoing PPCI for treatment of STEMI.

KW - Primary percutaneous coronary intervention

KW - ST segment elevation myocardial infarction

KW - SYNTAX score

UR - https://www.scopus.com/pages/publications/84904264120

U2 - 10.1016/j.ijcard.2014.05.029

DO - 10.1016/j.ijcard.2014.05.029

M3 - Article

C2 - 24882698

AN - SCOPUS:84904264120

SN - 0167-5273

VL - 175

SP - 314

EP - 322

JO - International Journal of Cardiology

JF - International Journal of Cardiology

IS - 2

ER -

The MI SYNTAX score for risk stratification in patients undergoing primary percutaneous coronary intervention for treatment of acute myocardial infarction: A substudy of the COMFORTABLE AMI trial

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