Korean Circ J.  2014 Jul;44(4):220-226. 10.4070/kcj.2014.44.4.220.

Pentraxin 3 Is Highly Specific for Predicting Anatomical Complexity of Coronary Artery Stenosis as Determined by the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Score

• Namazi MH
• Saadat H
• Safi M
• Vakili H
• Alipourparsa S
• Bozorgmanesh M
• Haybar H

• KMID: 2223882
• DOI: http://doi.org/10.4070/kcj.2014.44.4.220

Abstract

BACKGROUND AND OBJECTIVES
The aim of this study was to examine the hypothesis that pentraxin 3 (PTX3) can have a diagnostic value for predicting anatomical complexity of coronary artery stenosis as measured by the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score.
SUBJECTS AND METHODS
We investigated the association of systemic arterial PTX3 with SYNTAX score among 500 patients with ischemic heart disease assigned to medical treatment (251), percutaneous coronary intervention (PCI) (197), or coronary artery bypass graft (CABG) (52).
RESULTS
The clinical judgment of the cardiologists was near-perfectly concordant with the SYNTAX score. Mean {99% confidence intervals (CIs)} SYNTAX scores were 5.8 (5.1-6.6), 18.4 (17.1-19.8), and 33.2 (32.8-33.6) in patients assigned to medical therapy, PCI, and CABG, respectively. The AROC (95% CIs) for discriminating between patients with and without a high SYNTAX score (>23) was 0.920 (0.895-0.946) for systemic arterial levels of PTX3. As the systemic arterial level of PTX3 increased, the SYNTAX scores also increased almost in a curvilinear fashion, with the value corresponding to the SYNTAX score of 23 being 0.29 ng . dL-1. This cutpoint achieved a sensitivity of 0.66 (0.57-0.74), a specificity of 0.94 (0.91-0.96), a positive predictive value of 0.79 (0.70-0.87), and a negative predictive value of 0.89 (0.85-0.92).
CONCLUSION
We observed that systemic arterial levels of PTX3 were associated with the SYNTAX score in a curvilinear fashion. The discriminatory power of systemic arterial levels of PTX3 for a high SYNTAX score was excellent. The interesting finding of this study was the near perfect concordance between the decisions made by the cardiologists based on their clinical judgment and the SYNTAX score. The systemic arterial PTX3 level of 0.29 ng . dL-1 was highly specific for diagnosing complex coronary artery stenosis.

Keyword

PTX3 protein; Coronary artery disease; Percutaneous coronary intervention; Coronary artery bypass grafting; Angiography

MeSH Terms

Angiography
Coronary Artery Bypass
Coronary Artery Disease
Coronary Stenosis*
Humans
Judgment
Myocardial Ischemia
Percutaneous Coronary Intervention*
Sensitivity and Specificity
Taxus*
Thoracic Surgery*
Transplants

Figure

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  Fig. 1 Distribution of the SYNTAX score among patients assigned to different treatment modalities. SYNTAX: Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery, CABG: coronary artery bypass graft, PCI: percutaneous coronary intervention.

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  Fig. 2 Association between the systemic arterial pentraxin 3 and the SYNTAX score. Red- and green-colored lines indicate the 95% confidence intervals for the blue-colored main curve representing the association between the systemic arterial pentraxin 3 and the SYNTAX score. SYNTAX: Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery.

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