Development of one-year major adverse cardiac events risk index in patients with acute coronary syndrome and diabetes mellitus who underwent percutaneous coronary intervention
Abstract
Background/Aim. Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) have an increased risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI), which is not estimated sufficiently-multidimensionally in terms of type and severity of the ACS and/or DM and angiographic findings. The study was intended to validate and develop an index of metabolic, angiographic, anatomic and clinical risk factors for one-year MACE after conducted PCI in patients with ACS and DM. Methods. A prospective cross-sectional study was performed in patients with DM and ACS. In the PCI period the following risk factors were recorded: 1) age and metabolic variables – glycosylated hemoglobin (HbA1c), total cholesterol, and triglycerides levels in the blood; 2) endocrinological variables – DM therapy and type of DM; 3) ACS modality; 4) radiological/anatomical variable – SYNTAX score, and 5) clinical variables in modified age, creatinine, ejection fraction (ACEF) score. One-year MACE were recorded. Results. From a total of 136 consecutive patients, 55 of them developed at least one MACE in one-year follow-up. A high predictive risk index was evaluated that assessed particular or associated risks for one-year MACE (c statistic = 0.879) in the study population, defined by: SYNTAX score > 21, modified ACEF score > 1.38, HbA1c ≥ 8%, triglyceridemia ≥ 2.3 mmol/L in patients with insulin therapy, and ACS modality – unstable angina pectoris. The constructed risk index for one-year MACE (MACERI) had better predictive characteristics than SYNTAX score (c statistic = 0.798), as well as ACF score (c statistic = 0.744). Conclusion. MACERI can potentially have great application in future risk factors studies for one-year MACE in patients with DM and ACS who underwent PCI, because with it the effects of these factors are measured multidimensionally at valid and accurate manner.
References
Schwartz CJ, Valente AJ, Sprague EA, Kelley JL, Cayatte AJ, Rozek MM. Pathogenesis of the atheroclerotic lesion: Impli-cations for diabetes mellitus. Diabetes Care 1992; 15(9): 1156–67.
Kannel WB, McGee DL. Diabetes and Glucose tolerance as risk factor for cardiovascular disease. The Framingham Study. Diabetes Care 1979; 2(2): 120–6.
Hlatky MA, Boothroyd DB, Bravata DM, Boersma E, Booth J, Brooks MM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet 2009; 373(9670): 1190–7.
Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 2012; 367(25): 2375–84.
Dangas GD, Farkouh ME. CABG in insulin and non-insulin-treated diabetic patients: results from the FREEDOM tri-al. J Am Coll Cardiol 2014; 64(12): 1189–97.
De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 2012; 367(11): 991–1001.
Brkovic V, Dobric M, Beleslin B, Giga V, Vukcevic V, Stojkovic S et al. Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocar-dial infarction treated by primary percutaneous coronary intervention. Int J Cardiovasc Imaging 2013; 29(6): 1215–28.
Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIn-tervention 2005; 1(2): 219–27.
Serruys PW, Onuma Y, Garg S, Sarno G, van den Brand M, Kap-petein AP, et al. Assessment of the SYNTAX score in the SYNTAX study. EuroIntervention 2009; 5(1): 50–6.
Garg S, Girasis C, Sarno G, Goedhart D, Morel MA, Garcia-Garcia HM, et al. The SYNTAX score revisited: a reassess-ment of the SYNTAX score reproducibility. Catheter Car-diovasc Interv 2010; 75(6): 946–52.
Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360(10): 961–72.
Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E, et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYN-TAX trial. Eur Heart J 2011; 32(17): 2125–34.
Holmes DR, Vazales B, Cannon LA. TCT-228: Four years fol-low-up of the SYNTAX trial: optimal revascularization strategy in patients with three-vessel disease and/or left main disease. J Am Coll Cardiol 2009; 58: B61.
Mohr FW, Morice MC, Kappetein AP, Feldman E, Stahle MJ, Mack A, et al. Final five-year follow-up of the SYNTAX tri-al: optimal revascularization strategy in patients with three-vessel disease and/ or left main disease. Eur Heart J 2012; 33: 500.
Serruys PW, Onuma Y, Garg S, Vranckx P, De Bruyne B, Morice MC, et al. 5-year clinical outcomes of the arts II (arterial re-vascularization therapies study II) of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions. J Am Coll Cardiol 2010; 55(11): 1093–101.
Valgimigli M, Serruys PW, Tsuchida K, Vaina S, Morel MA, van den Brand MJ, et al. Cyphering the complexity of coronary artery disease using the SYNTAX score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention. Am J Cardiol 2007; 99(8): 1072–81.
Capodanno D, Di Salvo ME, Cincotta G, Miano M, Tamburino C, Tamburino C. Usefulness of the SYNTAX score for predict-ing clinical outcome after percutaneous coronary interven-tion of unprotected left main coronary artery disease. Circ Cardiovasc Interv 2009; 2(4): 302–8.
Capodanno D, Capranzano P, Di Salvo ME, Caggegi A, Tomasello D, Cincotta G, et al. Usefulness of SYNTAX score to select patients with left main coronary artery disease to be treated with coronary artery bypass graft. JACC Cardiovasc Interv 2009; 2(8): 731–8.
Onuma Y, Girasis C, Piazza N, Garcia-Garcia HM, Kukreja N, Garg S, et al. Long-term clinical results following stenting of the left main stem: insights from research (rapamycin-eluting stent evaluated at rotterdam cardiology hospital) and t-search (taxus-stent evaluated at rotterdam cardiology hospital) registries. JACC Cardiovasc Interv 2010; 3(6): 584–94.
Wykrzykowska JJ, Garg S, Girasis C, de Vries T, Morel MA, van Es GA, et al. Value of the SYNTAX score for risk assess-ment in the all-comers population of the randomized multi-center leaders (limus eluted from a durable versus erodible stent coating) trial. J Am Coll Cardiol 2010; 56: 272–77.
Lemesle G, Bonello L, de Labriolle A, Steinberg DH, Roy P, Pinto Slottow TL, et al. Prognostic value of the SYNTAX score in patients undergoing coronary artery bypass grafting for three-vessel coronary artery disease. Catheter Cardiovasc Interv 2009; 73(5): 612–7.
Capodanno D, Marcantoni C, Ministeri M, Dipasqua F, Zanoli L, Rastelli S, et al. Incorporating glomerular filtration rate or creatinine clearance by the modification of diet in renal dis-ease equation or the Cockcroft-Gault equations to improve the global accuracy of the Age, Creatinine, Ejection Frac-tion [ACEF] score in patients undergoing percutaneous coronary intervention. Int J Cardiol 2013; 168(1): 396‒402.
Reindl M, Reinstadler SJ, Tiller C, Kofler M, Theurl M, Klier N, et al. ACEF score adapted to ST-elevation myocardial in-farction patients: The ACEF-STEMI score. Int J Cardiol 2018; 264: 18–24.
Pivatto FJ, de Araújo GN, Valle FH, Bergoli LC, Machado GP, Führ B, et al. Comparison of Anatomical and Clinical Scores in Predicting Outcomes in Primary Percutaneous Coro-nary Intervention. Int J Cardiovasc Sci 2018; 31(1): 26–32.
Sullivan LM, Massaro JM, D’Agostino RB Sr. Presentation of multivariate data for clinical use: The framingham study risk score functions. Stat Med 2004; 23(10): 1631–60.
American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes—2018; Diabetes Care 2018; 41(Suppl 1): S55‒S64.
Catapano AL, Graham I, De Backer G, Wiklund O, Chapman JM, Drexel H, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal 2016; 37(39): 2999–3058.
Yadav M, Palmerini T, Caixeta A, Madhavan MV, Sanidas E, Kirtane AJ, et al. Prediction of Coronary Risk by SYNTAX and Derived Scores. Synergy Between Percutaneous Coro-nary Intervention With Taxus and Cardiac Surgery. J Am Coll Cardiol 2013; 62(14): 1219–30.
Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J, et al. Predictive accuracy of SYNTAX score for predict-ing long-term outcomes of unprotected left main coronary artery revascularization. Am J Cardiol 2011; 107(3): 360–6.
Ružičić D, Dobrić M, Vuković M, Hrnčić D, Đorđević S, Ružičić M, et al. The correlation of SYNTAX score by coronary angi-ography with breast arterial calcification by digital mam-mography. Clin Radiol 2017; 73(5): 454–9.
Ružičić D, Dobrić M, Vuković M, Hrnčić D, Đorđević S, Ružičić M, et al. Novel Assessment Tool For Coronary Artery Disease Severity During Screening Mammography. Health Care Women Int 2018; 39(10): 1075‒89.
Mack MJ, Prince SL, Herbert M, Brown PP, Palmer G, Edgerston JR, et al. Current clinical outcomes of percutaneous coro-nary intervention and coronary artery bypass grafting. Ann Thorac Surg 2008; 86(2): 496–503.