| Background and objective: Nowdays,there are plenty of scoring systems for predicting the clinical prognosis of patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).There are three kinds of score systems involving simple coronary anatomy scores,clinical scores and the combination of anatomical and clinical characteristics of various scores,and each system contains different scoring methods.The predictive value may distinctive when used for different populations.The purpose of this study was to compare the predictive value of Gensini score(GS),SYNTAX score(CSS),clinical SYNTAX score(CSS)and SYNTAX score?(SS2)for long-term clinical outcome in patients with acute myocardial infarction(AMI)after PCI.Methods:A retrospective analysis was performed on 643 consecutive patients with AMI who underwent percutaneous coronary intervention in Department of Cardiology,Affiliated Zhongshan Hospital of Dalian University from January 2010 to November2015.SS and GS were calculated according to the results of coronary angiography.CSS and SS2 were calculated by combining SS with clinical information.Patients were stratified into four groups according to each score quartiles:(1)SS: SS < 11(n=148),11?SS<17(n=168),17? SS< 23(n=163),SS? 23(n=164);(2)GS: GS< 35(n=161),35?GS< 49(n=159),49? GS< 73(n=159),SS? 73(n=164);(3)CSS: CSS <13(n=162),13?CSS <21(n=157),21 ?CSS <34(n=165),CSS? 34(n=159);(4)SS2: SS2 <25(n=169),25 ?SS2 <31(n=151),31? SS2< 38(n=155),SS2? 38(n=168).All patients were followed up for 1 year.The primary endpoint was major adverse cardiac events(MACE),including all-cause mortality,myocardial infarction,revascularization,and heart failure.Cox proportional hazard regression analyses were performed to evaluate the independent risk factors of MACE.Furthermore,receiver operator characteristic(ROC)curve was generated to compare the predictive ability of scores.Results:From low to high score groups,the rates of MACE were increased in every score system: GS(25.5%,30.8%,49.07%,49.4%,p<0.001),SS(20.3%,38.7%,45.4%,51.2%,p<0.001),CSS(20.9%,29.9%,44.8%,61.6%,p<0.001),SS2(22.5%,29.1%,38.1%,66.7%,p<0.001).The result of Cox proportional hazard regression analyses was as follows: SS(HR 1.264,95%CI 1.111-1.437,p<0.001),GS(HR 1.229,95%CI 1.082-1.396,p=0.001),CSS(HR 1.399,95%CI 1.230-1.591,p<0.001),SS2(HR 1.407,95 % CI 1.239-1.597,p<0.001).All four score systems independently predicted the rate of 1 year MACE in patients with AMI after PCI.The ROC analysis indicated that:(1)AUC for cardiac death were similar :GS(AUC=0.624),SS(AUC=0.625),CSS(AUC=0.667),and SS2(AUC=0.657);(2)The AUC of SS2(AUC=0.806,95%CI 0.730-0.882,p<0.001)to predict mortality were greater than SS(AUC=0.63295% CI 0.525-0.739,p=0.02)and GS(AUC=0.667 95% CI 0.558-0.775,p=0.003),and the difference was statistically significant(z test,all p<0.05);(3)AUC for cardiac death were as follows and had no difference: AUCGS= 0.676(95% CI:0.552-0.799,p=0.005),AUCSS=0.659(95% CI:0.542-0.776,p=0.011),AUCCSS=0.777(95%CI:0.674-0.879,p<0.001),AUCSS2=0.842(95% CI:0.773-0.911,p<0.001).(4)The AUC of SS2(AUC=0.705 95%CI 0.651-0.759,p<0.001)and CSS(AUC= 0.70195%CI 0.647-0.754,p<0.001)to predict heart failure were greater than SS(AUC=0.615 95%CI 0.556-0.674,p=0.02)and GS(AUC=0.619 95%CI 0.560-0.678,p=0.003)(z test,all p<0.05).Conclusion: 1.All the four score systems can predict MACE,all-cause mortality,cardiac death,and heart failure in patients with AMI after PCI.All score systems were independent predictors of 1-year MACE.2.GS and SS can can accurately predict revascularization,while other score systems can not.3.Only CSS and SS2 can predict myocardial infarction.4.Predictive accuracy for MACE and cardiac death was equal in each score.5.Predictive accuracy for all-cause mortality and heart failure was improved using CSS and SS2. |
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