TY - JOUR
T1 - A global risk approach to identify patients with left main or 3-vessel disease who could safely and efficaciously be treated with percutaneous coronary intervention
T2 - The SYNTAX trial at 3 years
AU - Serruys, Patrick W.
AU - Farooq, Vasim
AU - Vranckx, Pascal
AU - Girasis, Chrysafios
AU - Brugaletta, Salvatore
AU - Garcia-Garcia, Hector M.
AU - Holmes, David R.
AU - Kappetein, Arie Pieter
AU - Mack, Michael J.
AU - Feldman, Ted
AU - Morice, Marie Claude
AU - Ståhle, Elisabeth
AU - James, Stefan
AU - Colombo, Antonio
AU - Pereda, Peggy
AU - Huang, Jian
AU - Morel, Marie Angèle
AU - Van Es, Gerrit Anne
AU - Dawkins, Keith D.
AU - Mohr, Friedrich W.
AU - Steyerberg, Ewout W.
N1 - Funding Information:
The SYNTAX study was funded by Boston Scientific. Dr. Mack has served on the Speaker's Bureau of Boston Scientific, Cordis, and Medtronic. Dr. Feldman serves on the Speaker's Bureau of Boston Scientific; receives grant support from Abbott , Atritech , Boston Scientific , Edwards , and Evalve ; and consults for Abbott, Coherex, Intervalve, Square One, and W.L. Gore. Dr. Morice reports that her institution received a research grant from Boston Scientific . Dr. Dawkins, Ms. Pereda, and Dr. Huang are all full-time employees of Boston Scientific. Dr. Dawkins holds stock in Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Stephen G. Ellis, MD, served as Guest Editor for this paper. Drs. Serruys and Farooq contributed equally to this paper.
PY - 2012/6
Y1 - 2012/6
N2 - Objectives: The aim of this study was to assess the additional value of the Global Risk - a combination of the SYNTAX Score (SXscore) and additive EuroSCORE - in the identification of a low-risk population, who could safely and efficaciously be treated with coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). Background: PCI is increasingly acceptable in appropriately selected patients with left main stem or 3-vessel coronary artery disease. Methods: Within the SYNTAX Trial (Synergy between PCI with TAXUS and Cardiac Surgery Trial), all-cause death and major adverse cardiac and cerebrovascular events (MACCE) were analyzed at 36 months in low (GRC LOW) to high Global Risk groups, with Kaplan-Meier, log-rank, and Cox regression analyses. Results: Within the randomized left main stem population (n = 701), comparisons between GRC LOW groups demonstrated a significantly lower mortality with PCI compared with CABG (CABG: 7.5%, PCI: 1.2%, hazard ratio [HR]: 0.16, 95% confidence interval [CI]: 0.03 to 0.70, p = 0.0054) and a trend toward reduced MACCE (CABG: 23.1%, PCI: 15.8%, HR: 0.64, 95% CI: 0.39 to 1.07, p = 0.088). Similar analyses within the randomized 3-vessel disease population (n = 1,088) demonstrated no statistically significant differences in mortality (CABG: 5.2%, PCI: 5.8%, HR: 1.14, 95% CI: 0.57 to 2.30, p = 0.71) or MACCE (CABG: 19.0%, PCI: 24.7%, HR: 1.35, 95% CI: 0.95 to 1.92, p = 0.10). Risk-model performance and reclassification analyses demonstrated that the EuroSCORE--with the added incremental benefit of the SXscore to form the Global Risk--enhanced the risk stratification of all PCI patients. Conclusions: In comparison with the SXscore, the Global Risk, with a simple treatment algorithm, substantially enhances the identification of low-risk patients who could safely and efficaciously be treated with CABG or PCI.
AB - Objectives: The aim of this study was to assess the additional value of the Global Risk - a combination of the SYNTAX Score (SXscore) and additive EuroSCORE - in the identification of a low-risk population, who could safely and efficaciously be treated with coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). Background: PCI is increasingly acceptable in appropriately selected patients with left main stem or 3-vessel coronary artery disease. Methods: Within the SYNTAX Trial (Synergy between PCI with TAXUS and Cardiac Surgery Trial), all-cause death and major adverse cardiac and cerebrovascular events (MACCE) were analyzed at 36 months in low (GRC LOW) to high Global Risk groups, with Kaplan-Meier, log-rank, and Cox regression analyses. Results: Within the randomized left main stem population (n = 701), comparisons between GRC LOW groups demonstrated a significantly lower mortality with PCI compared with CABG (CABG: 7.5%, PCI: 1.2%, hazard ratio [HR]: 0.16, 95% confidence interval [CI]: 0.03 to 0.70, p = 0.0054) and a trend toward reduced MACCE (CABG: 23.1%, PCI: 15.8%, HR: 0.64, 95% CI: 0.39 to 1.07, p = 0.088). Similar analyses within the randomized 3-vessel disease population (n = 1,088) demonstrated no statistically significant differences in mortality (CABG: 5.2%, PCI: 5.8%, HR: 1.14, 95% CI: 0.57 to 2.30, p = 0.71) or MACCE (CABG: 19.0%, PCI: 24.7%, HR: 1.35, 95% CI: 0.95 to 1.92, p = 0.10). Risk-model performance and reclassification analyses demonstrated that the EuroSCORE--with the added incremental benefit of the SXscore to form the Global Risk--enhanced the risk stratification of all PCI patients. Conclusions: In comparison with the SXscore, the Global Risk, with a simple treatment algorithm, substantially enhances the identification of low-risk patients who could safely and efficaciously be treated with CABG or PCI.
KW - 3-vessel disease
KW - Global Risk
KW - SYNTAX Score
KW - left main disease
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U2 - 10.1016/j.jcin.2012.03.016
DO - 10.1016/j.jcin.2012.03.016
M3 - Article
C2 - 22721655
AN - SCOPUS:84862892413
VL - 5
SP - 606
EP - 617
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 6
ER -