Predicting 2-year all-cause mortality after contemporary PCI: Updating the logistic clinical SYNTAX score

Ply Chichareon, David van Klaveren, Rodrigo Modolo, Norihiro Kogame, Kuniaki Takahashi, Chun Chin Chang, Mariusz Tomaniak, Jinqing Yuan, Lihua Xie, Ying Song, Shubin Qiao, Yuejin Yang, Changdong Guan, Aleksander Zurakowski, Robert Jan van Geuns, Manel Sabate, Paul J. Ong, Joanna J. Wykrzykowska, Jan J. Piek, Scot GargChristian Hamm, Gabriel Steg, Pascal Vranckx, Marco Valgimigli, Stephan Windecker, Peter Juni, Yoshinobu Onuma, Ewout Steyerberg, Bo Xu*, Patrick W. Serruys

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Scopus)


Aims: We aimed to update the logistic clinical SYNTAX score to predict 2 year all-cause mortality after contemporary percutaneous coronary intervention (PCI). Methods and results: We analyzed 15,883 patients in the GLOBAL LEADERS study who underwent PCI. The logistic clinical SYNTAX model was updated after imputing missing values by refitting the original model (refitted original model) and fitting an extended new model (new model, with, selection based on the Akaike Information Criterion). External validation was performed in 10,100 patients having PCI at Fu Wai hospital. Chronic obstructive pulmonary disease, prior stroke, current smoker, hemoglobin level, and white blood cell count were identified as additional independent predictors of 2 year all-cause mortality and included into the new model. The c-indexes of the original, refitted original and the new model in the derivation cohort were 0.74 (95% CI 0.72–0.76), 0.75 (95% CI 0.73–0.77), and 0.78 (95% CI 0.76–0.80), respectively. The c-index of the new model was lower in the validation cohort than in the derivation cohort, but still showed improved discriminative ability of the newly developed model (0.72; 95% CI 0.67–0.77) compared to the refitted original model (0.69; 95% CI 0.64–0.74). The models overestimated the observed 2 year all-cause mortality of 1.11% in the Chinese external validation cohort by 0.54 percentage points, indicating the need for calibration of the model to the Chinese patient population. Conclusions: The new model of the logistic clinical SYNTAX score better predicts 2 year all-cause mortality after PCI than the original model. The new model could guide clinical decision making by risk stratifying patients undergoing PCI.

Original languageEnglish
Pages (from-to)1287-1297
Number of pages11
JournalCatheterization and Cardiovascular Interventions
Issue number7
Early online date4 Feb 2021
Publication statusPublished - 1 Dec 2021

Bibliographical note

Funding Information:
GLOBAL LEADERS study was sponsored by the European Clinical Research Institute, which received funding from Biosensors International, AstraZeneca, and the Medicines Company. The study funders had no role in trial design, data collection, analysis, interpretation of the data, preparation, approval, or making a decision to submit the manuscript or publication.

Funding Information:
Dr. Windecker reports research and educational grants from Amgen, Abbott, Bayer, BMS, Boston Scientific, Biotronik, CSL Behring, Medtronic, Edwards Lifesciences, Polares and Sinomed.

Funding Information:
Dr. Chichareon reports research grant from Biosensors International outside the submitted work.

Funding Information:
Dr. Modolo received research grant from Biosensors and from the Sao Paulo Research Foundation (FAPESP‐grant number 2017/22013–8).

Funding Information:
Dr. van Geuns, received speakers fee from Abbott Vascular. The Thoraxcenter, ErasmusMC, Rotterdam received research grants from Abbott Vascular and Boston Scientific.

Publisher Copyright:
© 2021 Wiley Periodicals LLC.


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