Comparison of Gensini score and SYNTAX score for predicting in-stent restenosis in patients with coronary artery disease and drug-eluting stent implantation

The present study was aimed to investigate whether Gensini score or SYNTAX score was a valuable tool to predict in-stent restenosis (ISR) in coronary artery disease (CAD) patients with drug-eluting stents (DES) implantation. A retrospective case-control study and a validating retrospective cohort study were designed. All subjects' information was collected from the First Affiliated Hospital of Xinjiang Medical University. A total of 916 patients were enrolled in the case-control study, and 961 subjects were included in the retrospective-cohort study. In the case-control study, significant differences were observed between the ISR and non-ISR groups regarding baseline characteristics and clinical examinations, including waist circumference, systolic blood pressure, blood glucose levels, ApoA1 levels, left ventricular ejection fraction, lesion vessels, Gensini score, and SYNTAX score (all P < 0.05). All parameters showing significant differences were also associated with ISR (all P < 0.05). However, after adjustment for confounders, both Gensini score [tertile 3 vs. tertile 1 with OR 95%CI: 15.61 (5.37-45.39)] and SYNTAX score [high risk ≥ 33 vs. low risk ≤ 22 with OR 95%CI 12.61 (5.14-30.94)] were still independently associated with ISR. Furthermore, Gensini score [AUC 95%CI: 0.81 (0.78-0.84)] and SYNTAX score [AUC 95%CI: 0.76 (0.72-0.79)] showed a moderate ability to predict ISR. The predictors were further verified in a cohort validation study, which confirmed that the Gensini score was a better predictor for ISR than SYNTAX score, with an AUC and 95%CI of 0.67 (0.60-0.73) and 0.53 (0.46-0.60), respectively. Gensini score showed a higher capability to predict ISR than SYNTAX score in CAD patients with DES implantation. SYNTAX score may also be a useful tool for assessing the risk of ISR in patients with multivessel lesions.