Clinical Research in Cardiology

, Volume 102, Issue 7, pp 495–503 | Cite as

Angiographic score assessment improves cardiovascular risk prediction: the clinical value of SYNTAX and Gensini application

  • Christoph Sinning
  • Lars Lillpopp
  • Sebastian Appelbaum
  • Francisco Ojeda
  • Tanja Zeller
  • Renate Schnabel
  • Edith Lubos
  • Annika Jagodzinski
  • Till Keller
  • Thomas Munzel
  • Christoph Bickel
  • Stefan BlankenbergEmail author
Original Paper



Severity of coronary artery disease (CAD) is related to cardiovascular outcome. We aimed to assess the long-term follow-up depending on Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) and Gensini score for prognosis. Both scores increase with complexity and thus reflect risk of cardiovascular events.

Methods and results

We determined complexity and extent of CAD by the SYNTAX and Gensini score in the AtheroGene cohort (N = 1,974, with 22.6 % women). The endpoint was non-fatal myocardial infarction (N = 132) and cardiovascular death (N = 159) over a median follow-up of 5.4 (Q1: 5.23/Q3: 5.57) years up to 8 years maximum (follow-up rate 99.4 %).

For SYNTAX score, the following distribution was used: low (≤22, N = 1,404), medium (23–32, N = 314), high score (>32, N = 256). Gensini score was split into thirds. Cox regression analysis showed a hazard ratio (HR) of 1.5 (95 % confidence interval 1.16–1.95; p = 0.0024) for the log transformed SYNTAX score in a fully adjusted model and a HR of 1.41 (95 % CI 1.13–1.77; p = 0.0025) for the Gensini score. The SYNTAX score alone had a C-index of 0.62, whereas adding clinical variables increased the C-index to 0.67. Similar results were obtained for the Gensini score. Regarding the SYNTAX score using net reclassification index, discrimination of events and non-events was enhanced by 37.2 % in a model of clinical variables and biomarkers and by 31.8 % for the Gensini score.


The SYNTAX and Gensini score in combination with clinical variables could be used to predict the cardiovascular prognosis during a long-term follow-up of up to 8 years in CAD patients.


Coronary artery disease Prognosis Risk stratification SYNTAX score Gensini score 



Acute coronary syndrome


Coronary artery disease


Coronary artery bypass grafting


Confidence interval


C-reactive protein


High density lipoprotein


Hazard ratio


Low density lipoprotein


N-terminal pro B-type natriuretic peptide


Net reclassification improvement


Non-ST-segment elevation infarction


Percutaneous coronary intervention


Standard deviation


ST segment elevation infarction


Synergy between percutaneous coronary intervention with taxus and cardiac surgery



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, Germany, and by a Grant from the Fondation de France (no. 2002004994).

Conflict of interest

The authors have no conflicts of interest to disclose.

Supplementary material

392_2013_555_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 kb)
392_2013_555_MOESM2_ESM.docx (12 kb)
Supplementary material 2 (DOCX 11 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Christoph Sinning
    • 1
  • Lars Lillpopp
    • 2
  • Sebastian Appelbaum
    • 1
  • Francisco Ojeda
    • 1
  • Tanja Zeller
    • 1
  • Renate Schnabel
    • 1
  • Edith Lubos
    • 1
  • Annika Jagodzinski
    • 1
  • Till Keller
    • 1
  • Thomas Munzel
    • 2
  • Christoph Bickel
    • 2
    • 3
  • Stefan Blankenberg
    • 1
    Email author
  1. 1.Department of General and Interventional CardiologyUniversity Heart Center HamburgHamburgGermany
  2. 2.II Department of MedicineUniversity Medical Center, Johannes Gutenberg UniversityMainzGermany
  3. 3.Department of Internal MedicineFederal Armed Forces Central HospitalKoblenzGermany

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