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SYNTAX score-0 patients: risk stratification in nonobstructive coronary artery disease

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Abstract

Background

The complexity of coronary artery disease (CAD) is a predictor of cardiovascular events in patients with >50 % diameter stenosis as determined by SYNTAX score. Here, we compare the Gensini score to SYNTAX in patients with CAD as well as apply the Gensini score in patients with nonobstructive CAD (NOB-CAD), defined by ≤50 % diameter stenosis, were the SYNTAX score cannot be utilized to define future risk.

Methods

The AtheroGene study enrolled 2316 patients [861/37.2 % with acute cardiovascular syndrome (ACS) and 1500/62.8 % with stable CAD (SCAD)]. Of these, 1966 had obstructive CAD (OB-CAD) with SYNTAX and Gensini scores available and 291 events with either cardiovascular mortality or non-fatal myocardial infarction were recorded. Furthermore, 350 patients had NOB-CAD with only Gensini score and 36 events. Median follow-up time was 4.9 years.

Results

In the OB-CAD cohort the SYNTAX and the Gensini score predicted outcome. Kaplan–Meier curve analysis with the dichotomized Gensini score showed a significant result (p = 0.04) in the NOB-CAD cohort. Cox Regression analysis after adjustment showed a hazard ratio (HR) of 1.33 and p = 0.04 for the Gensini score in the NOB-CAD cohort. Receiver operating characteristic curve (ROC) analysis provided the highest area under the curve (AUC) regarding the outcome for the Gensini score with 0.65 (p = 0.004). Comparing the SYNTAX and Gensini score in this cohort showed improved discrimination of patients with events by the Gensini score (p = 0.02).

Conclusion

The Gensini score predicted events in patients with ≤50 % diameter lesions. Utilization of this score is useful to define risk in NOB-CAD patients.

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Author notes

    Authors and Affiliations

    1. Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany

      Christoph Sinning, Elvin Zengin, Christoph Waldeyer, Moritz Seiffert, Renate B. Schnabel, Edith Lubos, Tanja Zeller, Stefan Blankenberg, Peter M. Clemmensen & Dirk Westermann

    2. Department of Internal Medicine, Federal Armed Forces Central Hospital, Koblenz, Germany

      Christoph Bickel

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    1. Christoph Sinning
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    Correspondence to Peter M. Clemmensen or Dirk Westermann.

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    All authors declare no conflicts of interest.

    Funding

    The AtheroGene study is supported by a Grant of the ‘Stiftung Rheinland-Pfalz für Innovation’, Ministry of Science and Education (AZ 15202–386261/545), Mainz, by the MAIFOR Grant 2001 of the Johannes Gutenberg-University Mainz, Germany, and by Grants from the Fondation de France (No. 2002004994), the French Ministry of Research (ACI IMPBIO 032619) and the Institut National de la Santé et de la Recherche Médicale (Programme National de Recherches sur les Maladies Cardiovasculaires A04052DS).

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    C. Sinning and E. Zengin both authors contributed equally.

    P. M. Clemmensen and D. Westermann both authors were equally senior authors of this study.

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    Sinning, C., Zengin, E., Waldeyer, C. et al. SYNTAX score-0 patients: risk stratification in nonobstructive coronary artery disease. Clin Res Cardiol 105, 901–911 (2016). https://doi.org/10.1007/s00392-016-0998-5

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