Clinical InvestigationAcute Ischemic Heart DiseaseComparison of clinical and angiographic prognostic risk scores in patients with acute coronary syndromes: Analysis from the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial
Section snippets
Study protocol
The ACUITY trial design has been previously reported in detail.12 Briefly, ACUITY was a large, international, multicenter, prospective randomized trial of patients with moderate- and high-risk NSTEACS undergoing an early invasive strategy. Patients were randomly assigned before coronary angiography to heparin (unfractionated or enoxaparin) plus a glycoprotein IIb/IIIa inhibitor, bivalirudin plus a glycoprotein IIb/IIIa inhibitor, or bivalirudin monotherapy. Coronary angiography was performed in
Results
The study flow diagram is shown in Figure 1. A total of 2,094 patients with NSTEACS undergoing PCI were included, in whom a 1-year follow-up was available in 2,001 patients (96%). Clinical and angiographic characteristics of patients included vs those not included in this study are shown in the online Appendix Supplemental Table 1. Descriptive statistics for the 6 scores are reported in the online Appendix Supplemental Table 2.
Discussion
Assessing the performance of prediction models is a complex process that requires the evaluation of several performance measures.22 Traditional measures for survival outcomes include discrimination, usually expressed as c statistic, and calibration, usually measured with the Hosmer-Lemeshow test.17 Discrimination is a measure of how well the prognostic model can separate cases from controls, whereas calibration is a measure of how well predicted probabilities fit actual risks. Typically,
Disclosures
Conflict of interest: Dr Mehran is a consultant for Abbott Vascular, AstraZeneca, Ortho-McNeil, and Regado Biosciences and has received research grant from Sanofi/Bristol Myers Squibb. Dr Dangas has received honoraria from The Medicines Company. Martin Fahy, Ke Xu, Dr Cristea, Dr Lazar, and Dr Sanchez are employed by the Cardiovascular Research Foundation. Dr Stone is a consultant to Abbott Vascular, Boston Scientific, The Medicines Company, and Medtronic.
References (28)
- et al.
The electrocardiogram predicts one-year outcome of patients with unstable angina and non–Q wave myocardial infarction: results of the TIMI III Registry ECG Ancillary Study. Thrombolysis in Myocardial Ischemia
J Am Coll Cardiol
(1997) - et al.
ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
J Am Coll Cardiol
(2007) - et al.
Comparison between the NERS (New Risk Stratification) score and the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score in outcome prediction for unprotected left main stenting
JACC Cardiovasc Interv
(2010) - et al.
Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial: study design and rationale
Am Heart J
(2004) What price perfection? Calibration and discrimination of clinical prediction models
J Clin Epidemiol
(1992)- et al.
Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) Trial
J Am Coll Cardiol
(2011) - et al.
Value of the SYNTAX score for risk assessment in the all-comers population of the randomized multicenter LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial
J Am Coll Cardiol
(2010) - et al.
Global risk classification and clinical SYNTAX (synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) score in patients undergoing percutaneous or surgical left main revascularization
JACC Cardiovasc Interv
(2011) - et al.
EuroSCORE refines the predictive ability of SYNTAX score in patients undergoing left main percutaneous coronary intervention
Am Heart J
(2010) - et al.
The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making
JAMA
(2000)