Journal
CLINICAL RESEARCH IN CARDIOLOGY
Volume 105, Issue 11, Pages 901-911Publisher
SPRINGER HEIDELBERG
DOI: 10.1007/s00392-016-0998-5
Keywords
Nonobstructive coronary artery disease; Obstructive coronary artery disease; SYNTAX score; Gensini score; Prognosis
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Funding
- 'Stiftung Rheinland-Pfalz fur Innovation', Ministry of Science and Education, Mainz [AZ 15202-386261/545]
- MAIFOR of the Johannes Gutenberg-University Mainz, Germany
- Fondation de France [2002004994]
- French Ministry of Research (ACI IMPBIO) [032619]
- Institut National de la Sante et de la Recherche Medicale (Programme National de Recherches sur les Maladies Cardiovasculaires) [A04052DS]
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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 aecurrency sign50 % diameter stenosis, were the SYNTAX score cannot be utilized to define future risk. 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. 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). The Gensini score predicted events in patients with aecurrency sign50 % diameter lesions. Utilization of this score is useful to define risk in NOB-CAD patients.
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