SXscore Tertile Research Articles

Lipid Fractions and Severity of Coronary Artery Lesions in Acute Myocardial Infarction: A Retrospective Single-Center Study

The relationship between different lipid fractions and the occurrence of atherosclerotic coronary artery disease(CAD) is a well-known fact. However, knowledge of the association of different lipid fractions and the severity and extension of coronary lesions has been rarely reported in clinical studies and is often contradictory. This study aimed to evaluate the association between different lipid fractions and the severity and extent of the coronary atherosclerotic lesion in patients with ST elevated acute myocardial infarction (STEMI). We analyzed data from 50 consecutive patients with STEMI who underwent coronary angiography during hospitalization at the Clinical Hospital in Tetovo. The severity and extent of CAD were defined using the Syntax score (SXscore) algorithm stratified according to tertiles. Laboratory analysis for lipid fractions was performed. It was noticed a statistically significant association between SXscore tertiles and the mean of total cholesterol (TC) to high-density lipoprotein cholesterol (HDL) ratio (TC/HDL), (p=0.008). Correlation test showed week but significant positive correlation between SXscore tertiles and TC/HDL ratio (r=0.339, p=0.016) and Non-HDL (r=0.309, p=0.034). In regression analysis, reduced HDL and increased TC values statistically significantly predicted SXscore (p<0.05). Among all lipid variables examined, the TC/HDL ratio appeared as the most powerful indicator of severity and extension of the coronary lesion in patients with STEMI. The TC/HDL ratio should be used as an easy, non-invasive, and inexpensive method to measure the severity of CAD to determine the diagnosis strategy and treatment of patients with atherosclerotic coronary diseases at risk of acute infarction.

Outcomes of bioresorbable vascular scaffolds versus everolimus-eluting stents by coronary complexity: a sub-analysis of the AIDA trial.

We aimed to evaluate the impact of the complexity of coronary disease as assessed by the SYNTAX score (SXscore) on the clinical outcomes in the AIDA trial. In the AIDA trial, we compared Absorb versus XIENCE in routine clinical practice. Clinical outcomes were stratified by SXscore tertiles: SXlow (SXscore ≤8), SXmid (SXscore >8 and ≤15) and SXhigh (>15). The SXscore was available in 1,661 of the 1,845 (90%) patients. The event rate of TVF was numerically lower in Absorb compared to XIENCE (3.7% versus 5.6%; p=0.257) in the SXlow tertile, numerically higher in Absorb in the SXmid tertile (11.4% versus 9.3%, p=0.421) and similar in the SXhigh tertile (15.5% versus 15.6%; p=0.960). The rates of definite/probable device thrombosis in Absorb versus XIENCE were significantly higher in the SXmid tertile (3.3% versus 0.8%, p=0.043) and in the SXhigh tertile (3.7% versus 0.8%, p=0.006). We found no significantly different rates of TVF between Absorb and XIENCE patients. Absorb-treated patients in the SXmid and SXhigh tertiles had an increased risk of device thrombosis when compared to XIENCE-treated patients. The rates of device thrombosis in the SXlow tertile, while still higher for Absorb, are more acceptable than in the SXmid and SXhigh score tertiles.

P2808Absorb bioresorbable scaffold vs. Xience metallic stent: outcomes in the AIDA trial stratified by SYNTAX score

Abstract Aims Extent of coronary artery disease (CAD) may affect outcomes after percutaneous coronary intervention (PCI). In this pre-specified subgroup analysis of the AIDA trial we evaluated the impact of SXscore on clinical outcomes Methods and results AIDA was a multicenter trial comparing Absorb with Xience. SX score was assessed using the baseline diagnostic angiograms. Each coronary lesion with diameter stenosis ≥50% in vessels ≥1.5 mm was scored. All lesion scores were combined to provide the overall SXscore. The angiographic SXscore calculations were performed by core laboratory analysts who were blinded for clinical events (Cardialysis B.V., Rotterdam, The Netherlands). Clinical outcomes were subsequently stratified according to SXscore tertiles: SXlow (SXcore ≤8), SXmid (SXscore >8 and ≤15) and SXhigh (>15). The primary endpoint of this AIDA-trial substudy was target vessel failure (TVF), defined as a composite of cardiac death, target vessel myocardial infarction and target vessel revascularization. The SXscore was prospectively calculated in 1661 of the 1845 patients (90%). The SXscore ranged from 1 to 57, with a mean±SD of 12.9±8.5 and a median of 11 (Q1-Q3 7–17). In this analysis the SXscore tertiles were defined as SXlow (SXcore ≤8) (n=589), SXmid (SXscore >8 and ≤15) (n=538), and SXhigh (>15) (n=534). Patients in the SXhigh group were older, had a more extensive medical history for previous revascularizations (both PCI and coronary artery bypass grafting), and were more likely to present with a ST-elevation myocardial infarction. At 2 follow-up the Kaplan-Meier estimates of TVF for the overall AIDA study population was 15.5% in the SXhigh tertile, 10.4% in the SXmid tertile and 4.7% in the SXlow tertile (hazard ratio (HR) 3.53 95% CI 2.28–5.45; P<0.001). The event rate of the primary endpoint of TVF was numerically lower in Absorb when compared to Xience (3.7% versus 5.6%; HR 0.64; 95% CI 0.29 - 1.40; p=0.257) in the SXlow tertile. Patients treated with Absorb and a SXscore >8 had significantly higher event rates as compared to patients with a SXscore ≤8. The rates of TVF in the Absorb BVS population are 15.5% (SXhigh), 11.4% (SXmid), and 3.7% (SXlow), with a significant difference between the SXlow versus SXmid (HR 3.27; 95% CI 1.61–6.68; p=0.001) and SXlow versus SXhigh (HR 4.57; 95% CI 2.29–9.10; p<0.001). Target Vessel Failure in Absorb BVS Conclusions This study demonstrates that implantation of the Absorb in patients with a SXscore ≤8 is associated with numerically lower TVF rates as compared to the Xience drug-eluting stent. The rate of scaffold thrombosis in this SXlow tertile, while still higher for Absorb, is more acceptable than in SXmid and SXhigh score tertiles. Higher SXscore (i.e. >8), both Sxmid and SXhigh, however, appears to be associated with markedly increased risk of device thrombosis, revascularization and myocardial infarction in patients treated with the Absorb. Acknowledgement/Funding The AIDA trial was financially supported by an unrestricted research grant from Abbott Vascular

Highly-Sensitive C-reactive Protein Level and its Association with Intermediate and High Syntax Score in cases of Acute Coronary Syndrome

Background: Highly-Sensitive C-reactive Protein (hs-CRP) levels are associated with short- and long-term mortality in patients with acute coronary syndrome (ACS). Aim: We investigated if baseline hs-CRP levels are correlated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). Subjects and methods: We investigated 200 patients with ACS who underwent coronary angiography. The patients were divided into groups based on their SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23). Results: Patients in the intermediate-high SXScore group had higher serum hs-CRP levels in comparison to low SXScore group (4.61 ±1.54 mg/dL versus 2.37 ± 0.66 mg/dL, P < 0.001). The mean age of patients and prevalence of diabetes in the intermediate-high SXScore group were statistically insignificantly than in the low SXScore group. Left ventricular ejection fraction (LVEF) was significantly lower in the patients with an intermediate-high SXScore (41±9 %) compared to low SXScore tertiles (50±8 %) (P< 0.001). There was significant correlation between the hs-crp levels and the syntax score. The correlation coefficient (r) = 0.567, also p value was significant p=0.0001. Consecutively hs-CRP at a cut-off point of ≥ 2.5mg/L was highly sensitive (97%) and specific (41%) and was a strongly independent predictor of a high SXScore in patients with ACS. Where accuracy of test was (acc= 0.94). Conclusion: It is believed that serum levels of hs-CRP on admission in patients with ACS thought to be a strong predictor of the severity and complexity of coronary atherosclerosis together with multivessel disease, and LVEF.

Highly-Sensitive C-reactive Protein Level and its Association with Intermediate and High Syntax Score in cases of Acute Coronary Syndrome

Background: Highly-Sensitive C-reactive Protein (hs-CRP) levels are associated with short- and long-term mortality in patients with acute coronary syndrome (ACS). Aim: We investigated if baseline hs-CRP levels are correlated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). Subjects and methods: We investigated 200 patients with ACS who underwent coronary angiography. The patients were divided into groups based on their SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23). Results: Patients in the intermediate-high SXScore group had higher serum hs-CRP levels in comparison to low SXScore group (4.61 ±1.54 mg/dL versus 2.37 ± 0.66 mg/dL, P < 0.001). The mean age of patients and prevalence of diabetes in the intermediate-high SXScore group were statistically insignificantly than in the low SXScore group. Left ventricular ejection fraction (LVEF) was significantly lower in the patients with an intermediate-high SXScore (41±9 %) compared to low SXScore tertiles (50±8 %) (P< 0.001). There was significant correlation between the hs-crp levels and the syntax score. The correlation coefficient (r) = 0.567, also p value was significant p=0.0001. Consecutively hs-CRP at a cut-off point of ≥ 2.5mg/L was highly sensitive (97%) and specific (41%) and was a strongly independent predictor of a high SXScore in patients with ACS. Where accuracy of test was (acc= 0.94). Conclusion: It is believed that serum levels of hs-CRP on admission in patients with ACS thought to be a strong predictor of the severity and complexity of coronary atherosclerosis together with multivessel disease, and LVEF.

0279 : Correlation of CRP level with intermediate and high SYNTAX score in patients with acute coronary syndrome

C-reactive protein is currently considered as a prognostic marker of atherosclerotic disease. Its serum levels can help to stratify patients admitted for acute coronary syndrome (ACS). In our data, we investigated whether baseline CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). we enrolled 128 patients with ACS who underwent coronary angiography between January 2015 and November 2015. The patients were divided into tertiles according to the SXScore: low SXScore (≤22), and intermediate-high SXScore (≥23). Subjects in the intermediate-high SXScore tertile had higher serum CRP levels compare to low SXScore tertile patients (17.8±6.4 mg/L versus 10.2±5.3 mg/L, p < 0.001). The mean age of patients and prevalance of diabetes in the intermediate-high SXScore tertile were significantly higher than in the low SXScore tertile (61± 12 versus 57± 10 years; p=0.003 for age, p=0.008 for diabetes). Multivariate logistic regression analysis showed that the strongest predictors of high SXScore were increased serum CRP levels together with multivessel disease, left ventricular ejection fraction (LVEF), and troponin levels. Serum CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis. Thus, increased serum levels of CRP were one of the strong predictors of high SXScore in ACS patients. The author hereby declares no conflict of interest

High Sensitive CRP Level Is Associated With Intermediate and High Syntax Score in Patients With Acute Coronary Syndrome.

High sensitive C-reactive protein (hs-CRP) levels are associated with short- and long-term mortality in patients with acute coronary syndrome (ACS). We investigated whether baseline hs-CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore).We enrolled 321 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23).Subjects in the intermediate-high SXScore tertile had higher serum hs-CRP levels compare to low SXScore tertile patients (7.7 ± 3.4 mg/L versus 4.9 ± 2.5 mg/L, P < 0.001). The mean age of patients and prevalance of diabetes in the intermediate-high SXScore tertile were significantly higher than in the low SXScore tertile (63 ± 13 versus 58 ± 12 years P = 0.001 for age, P = 0.007 for diabetes). Multivariate logistic regression analysis showed that the strongest predictors of high SXScore were increased serum hs-CRP levels (OR: 1.14) together with multivessel disease (OR: 0.23), left ventricular ejection fraction (LVEF) (OR: 0.90), and troponin levels (OR: 1.12).Serum hs-CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis together with multivessel disease, LVEF, and troponin levels. Thus, increased serum levels of hs-CRP were one of the strong predictors of high SXScore in ACS patients.

N-Terminal Pro-Brain Natriuretic Peptide Level is Associated With Severity and Complexity of Coronary Atherosclerosis in Patients With Acute Coronary Syndrome.

N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are associated with short- and long-term mortality in acute coronary syndrome (ACS). We investigated whether baseline NT-proBNP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). We enrolled 509 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤ 22), intermediate SXScore (23-32), and high SXScore (≥ 33). The NT-proBNP levels demonstrated an increase from low SXScore tertile to high SXScore tertile. The NT-proBNP levels according to the SXScore tertiles are as follows: low and intermediate (median 635 vs 1635, P = .014), low and high (median 635 vs 4568, P < .001), and intermediate and high (median 1635 vs 4568, P < .001). In multivariate analysis, NT-proBNP remained an independent predictor of high SXScore (odds ratio: 2.688, 95% confidence interval: 1.315-5.494, P = .007) together with age (P = .002), neutrophil-lymphocyte ratio (P = .017), and presence of non-ST-segment elevation ACS (P = .002). The NT-proBNP was independently associated with burden of coronary atherosclerosis in patients with ACS.

The MI SYNTAX score for risk stratification in patients undergoing primary percutaneous coronary intervention for treatment of acute myocardial infarction: A substudy of the COMFORTABLE AMI trial

BackgroundTo investigate the performance of the MI Sxscore in a multicentre randomised trial of patients undergoing primary percutaneous coronary intervention (PPCI). Methods and resultsThe MI Sxscore was prospectively determined among 1132 STEMI patients enrolled into the COMFORTABLE AMI trial, which randomised patients to treatment with bare-metal (BMS) or biolimus-eluting (BES) stents. Patient- (death, myocardial infarction, any revascularisation) and device-oriented (cardiac death, target-vessel MI, target lesion revascularisation) major adverse cardiac events (MACEs) were compared across MI Sxscore tertiles and according to stent type.The median MI SXscore was 14 (IQR: 9–21). Patients were divided into tertiles of Sxscorelow (≤10), Sxscoreintermediate (11–18) and Sxscorehigh (≥19). At 1year, patient-oriented MACE occurred in 15% of the Sxscorehigh, 9% of the Sxscoreintermediate and 5% of the Sxscorelow tertiles (p<0.001), whereas device-oriented MACE occurred in 8% of the Sxscorehigh, 6% of the Sxscoreintermediate and 4% of the Sxscorelow tertiles (p=0.03). Addition of the MI Sxscore to the TIMI risk score improved prediction of patient- (c-statistic value increase from 0.63 to 0.69) and device-oriented MACEs (c-statistic value increase from 0.65 to 0.70). Differences in the risk for device-oriented MACE between BMS and BES were evident among Sxscorehigh (13% vs. 4% HR 0.33 (0.15–0.74), p=0.007 rather than those in Sxscorelow: 4% vs. 3% HR 0.68 (0.24–1.97), p=0.48) tertiles. ConclusionsThe MI Sxscore allows risk stratification of patient- and device-oriented MACEs among patients undergoing PPCI. The addition of the MI Sxscore to the TIMI risk score is of incremental prognostic value among patients undergoing PPCI for treatment of STEMI.

GW24-e1017 Association of cystatin C-based glomerular filtration rate with SYNTAX score in patients with diabetes

ObjectivesSerum cystatin C has been proposed as a better marker of glomerular filtration rate than serum creatinine. SYNTAX score (SXscore) can accurately reflect the severity of coronary artery disease (CAD)....

Association of Cystatin C-Based Glomerular Filtration Rate with SYNTAX Score in Patients with Diabetes

Serum cystatin C has been proposed as a better marker of glomerular filtration rate than serum creatinine. SYNTAX score (SXscore) can accurately reflect the severity of coronary artery disease (CAD). However, the association between Cystatin C-based glomerular filtration rate (eGFRcys) and SXscore in patients with diabetes has never been reported. We prospectively included 656 consecutive patients with diabetes who were angiographically diagnosed with CAD from January 2010 to December 2011. Renal function was assessed by eGFRcys. SXscore was calculated using SXscore algorithm. Ordinal logistic regression and Pearson correlation were used to analyze the association between eGFRcys and SXscore. Patients with renal dysfunction were older, more often female, more likely to have a history of hypertension and less tobacco use when compared with those patients with normal renal function. Age, sex, SBP, DBP, fasting glucose, HbA1c, TC, LDL, HDL, TG, BMI and CRP were not different among SXscore tertile groups. Incidence of hypertension, hyperlipidemia, family history and tobacco use were similar among these groups. Correlation analysis suggested that eGFRcys was negatively correlated with SXscore (R=-0.255, P<0.001). Ordinal logistic regression showed that eGFRcys was an independent predictor of SXscore (β=-0.027, P<0.001). eGFRcys was an independent predictor of SXscore in patients with diabetes. This might help explain the increased risk of CVD events and mortality in patients with renal dysfunction. Further prospectively multiple centre studies are required to better quantify this finding.

Implantation of the biodegradable polymer biolimus-eluting stent in patients with high SYNTAX score is associated with decreased cardiac mortality compared to a permanent polymer sirolimus-eluting stent: two year follow-up results from the "Call-comers" LEADERS trial

The SYNTAX score (SXscore) has been shown to be an effective predictor of clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). The SXscore was prospectively collected in 1,397 of the 1,707 patients enrolled in the "all-comers" LEADERS trial (patients post-surgical revascularisation were excluded). Post hoc analysis was performed by stratifying clinical outcomes at two-year follow-up, according to one of three SXscore tertiles: SXlow ≤8 (n=464), 8<SXmid ≤16 (n=472) and SXhigh >16 (n=461). At two-year follow-up the rate of major adverse cardiovascular events was 18.4%, 12.0% and 9.4% in the SXhigh, SXmid, and SXlow tertile, respectively (HR 1.45; CI 1.21-1.74; p<0.01). There was a significantly higher rate of cardiac death in patients in the highest SXscore tertile (7% SXhigh versus 2.4% SXmid versus 1.8% SXlow; HR 2.22; CI 1.5-3.27; p<0.001). Within the SXhigh tertile the rate of cardiac death was significantly lower in patients treated with the biolimus-eluting stent compared with the sirolimus-eluting stent (4.7% versus 9.6%, HR 0.48; CI 0.23-0.99; p=0.046). The SXscore when applied to an "all-comers" patient population allows for prospective risk stratification of patients undergoing PCI up to two years follow-up. In addition, the SXscore appears to separate the performance of devices in high risk patient groups.

The Prognostic Utility of the SYNTAX Score on 1-Year Outcomes After Revascularization With Zotarolimus- and Everolimus-Eluting Stents: A Substudy of the RESOLUTE All Comers Trial

This study assessed the ability of the SYNTAX score (SXscore) to stratify risk in patients treated with percutaneous coronary intervention (PCI) using zotarolimus-eluting or everolimus-eluting stents. The SXscore can identify patients treated with PCI who are at highest risk of adverse events. The SXscore was calculated prospectively in 2,033 of the 2,292 patients enrolled in the RESOLUTE All Comers study (RESOLUTE III All Comers Trial: A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention). Clinical outcomes in terms of a patient-oriented composite endpoint (POCE) of all-cause death, myocardial infarction (MI), and repeat revascularization; the individual components of POCE; target lesion failure (TLF) (a composite of cardiac death, target-vessel MI, and clinically driven target lesion revascularization); and stent thrombosis were subsequently stratified according to SXscore tertiles: SXscore(LOW) ≤ 9 (n = 698), 9 <SXscore(MID) ≤ 17 (n = 676); SXscore(HIGH) >17 (n = 659). At 12-month follow-up, rates of POCE, MI, repeat revascularization, TLF, and the composite of death/MI were all significantly higher in patients in the highest SXscore tercile. Rates of stent thrombosis were all highest in the SXscore(HIGH) tertile (p > 0.05). After multivariate adjustment, the SXscore was identified as an independent predictor of POCE, MI, repeat revascularization, and TLF (p < 0.05 for all). At 12-month follow-up, the SXscore, ACEF score, and Clinical SXscore had C-statistics of 0.57, 0.78, and 0.67, respectively, for mortality and of 0.62, 0.56, 0.63, respectively, for POCE. No significant between-stent differences were observed for TLF or POCE in any of the SXscore tertiles. The SYNTAX score is able to stratify risk amongst an all-comers population treated with PCI with second-generation drug-eluting stents (DES); however, improvements can be made with the inclusion of clinical variables. (RESOLUTE III All Comers Trial: A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention; NCT00617084).

Prediction of 1-Year Clinical Outcomes Using the SYNTAX Score in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Substudy of the STRATEGY (Single High-Dose Bolus Tirofiban and Sirolimus-Eluting Stent Versus Abciximab and Bare-Metal Stent in Acute Myocardial Infarction) and MULTISTRATEGY (Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent

This study sought to evaluate the impact of SYNTAX score (SXscore), and compare its performance in isolation and combination with the PAMI (The Primary Angioplasty in Myocardial Infarction Study) score, for the prediction of 1-year clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Patients with STEMI were excluded from the original SYNTAX score (SXscore) algorithm. Therefore, the utility of using the SXscore in this patient group remains undefined. SXscore was calculated retrospectively in 807 patients with STEMI enrolled in the randomized STRATEGY (Single High-Dose Bolus Tirofiban and Sirolimus-Eluting Stent Versus Abciximab and Bare-Metal Stent in Acute Myocardial Infarction) and MULTISTRATEGY (Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study) clinical trials. Clinical outcomes of all-cause death, reinfarction, and clinically driven target vessel revascularization were subsequently stratified according to SXscore tertiles: SXLOW ≤9 (n = 311), 9 < SXMID ≤16 (n = 234), SXHIGH >16 (n = 262). At 1-year follow-up, all clinical outcomes including mortality, mortality/reinfarction, major adverse cardiac events (MACE) (a composite of all-cause death, reinfarction and target vessel revascularization), and definite, definite/probable, and any stent thrombosis were all significantly higher in patients in the highest SXscore tertile. SXscore was identified as an independent predictor of mortality, MACE, and stent thrombosis out to 1-year follow-up. The combination SYNTAX-PAMI score led to a net reclassification improvement of 15.7% and 4.6% for mortality and MACE, respectively. The C-statistics for the SXscore, PAMI score, and the combined SYNTAX-PAMI score were 0.65, 0.81, and 0.73 for 1-year mortality, and 0.68, 0.64, and 0.69 for 1-year MACE, respectively. SXscore does have a role in the risk stratification of patients with STEMI having primary percutaneous coronary intervention; however, this ability can be improved through a combination with clinical variables. (Multicentre 2×2 Factorial Randomised Study Comparing Tirofiban Versus Abciximab and SES Versus BMS in AMI; NCT00229515)

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

The Syntax score (SXscore) was recently developed as a comprehensive angiographic scoring system aiming to assist in patient selection and risk stratification of patients with extensive coronary artery disease undergoing contemporary revascularization. A validation of this angiographic classification scheme is lacking. We assessed its predictive value in patients who underwent percutaneous intervention (PCI) for 3-vessel disease and explored its performance in comparison with the modified lesion classification system of the American Heart Association/American College of Cardiology. The SXscore, applied to 1,292 lesions in 306 patients who underwent PCI for 3-vessel disease in the Arterial Revascularization Therapies Study Part II, was 4 to 54.5, and after a median of 370 days (range 274 to 400) predicted the rate of major adverse cardiac and cerebrovascular events (hazard ratio 1.08/U increase, 95% confidence interval 1.05 to 1.11, p <0.0001), with patients in the highest SXscore tertile having a significantly higher event rate (27.9%) than patients in the lowest tertile (8.7%, hazard ratio 3.5, 95% confidence interval 1.7 to 7.4, p = 0.001). By multivariable analyses, SXscore independently predicted outcome with an almost fourfold adjusted increase in the risk of major adverse cardiac and cerebrovascular events in patients with high versus low values based on the discrimination level provided by classification and regression tree analysis. Compared with the modified lesion classification scheme of the American Heart Association/American College of Cardiology, SXscore showed a greater discrimination ability (c-index 0.58 +/- 0.08 vs 0.67 +/- 0.08, respectively, p <0.001) and a better goodness of fit with the Hosmer-Lemeshow statistic. In conclusion, the SXscore is a promising tool to risk stratify outcome in patients with extensive coronary artery disease undergoing contemporary PCI.