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: The SYNTAX trial at 3 years

Patrick W. Serruys, Vasim Farooq, Pascal Vranckx, Chrysafios Girasis, Salvatore Brugaletta, Hector M. Garcia-Garcia, David Holmes, Arie Pieter Kappetein, Michael J. Mack, Ted Feldman, Marie Claude Morice, Elisabeth Ståhle, Stefan James, Antonio Colombo, Peggy Pereda, Jian Huang, Marie Angèle Morel, Gerrit Anne Van Es, Keith D. Dawkins, Friedrich W. MohrEwout W. Steyerberg

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)606-617
Number of pages12
JournalJACC: Cardiovascular Interventions
Volume5
Issue number6
DOIs
StatePublished - Jun 1 2012
Externally publishedYes

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Percutaneous Coronary Intervention
Coronary Artery Bypass
Transplants
Confidence Intervals
Population
Mortality
Thoracic Surgery
Coronary Artery Disease
Cause of Death
Regression Analysis

Keywords

  • 3-vessel disease
  • Global Risk
  • left main disease
  • SYNTAX Score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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 : The SYNTAX trial at 3 years. / Serruys, Patrick W.; Farooq, Vasim; Vranckx, Pascal; Girasis, Chrysafios; Brugaletta, Salvatore; Garcia-Garcia, Hector M.; Holmes, David; Kappetein, Arie Pieter; Mack, Michael J.; Feldman, Ted; Morice, Marie Claude; Ståhle, Elisabeth; James, Stefan; Colombo, Antonio; Pereda, Peggy; Huang, Jian; Morel, Marie Angèle; Van Es, Gerrit Anne; Dawkins, Keith D.; Mohr, Friedrich W.; Steyerberg, Ewout W.

In: JACC: Cardiovascular Interventions, Vol. 5, No. 6, 01.06.2012, p. 606-617.

Research output: Contribution to journalArticle

Serruys, PW, Farooq, V, Vranckx, P, Girasis, C, Brugaletta, S, Garcia-Garcia, HM, Holmes, D, Kappetein, AP, Mack, MJ, Feldman, T, Morice, MC, Ståhle, E, James, S, Colombo, A, Pereda, P, Huang, J, Morel, MA, Van Es, GA, Dawkins, KD, Mohr, FW & Steyerberg, EW 2012, '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: The SYNTAX trial at 3 years', JACC: Cardiovascular Interventions, vol. 5, no. 6, pp. 606-617. https://doi.org/10.1016/j.jcin.2012.03.016
Serruys, Patrick W. ; Farooq, Vasim ; Vranckx, Pascal ; Girasis, Chrysafios ; Brugaletta, Salvatore ; Garcia-Garcia, Hector M. ; Holmes, David ; Kappetein, Arie Pieter ; Mack, Michael J. ; Feldman, Ted ; Morice, Marie Claude ; Ståhle, Elisabeth ; James, Stefan ; Colombo, Antonio ; Pereda, Peggy ; Huang, Jian ; Morel, Marie Angèle ; Van Es, Gerrit Anne ; Dawkins, Keith D. ; Mohr, Friedrich W. ; Steyerberg, Ewout W. / 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 : The SYNTAX trial at 3 years. In: JACC: Cardiovascular Interventions. 2012 ; Vol. 5, No. 6. pp. 606-617.
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abstract = "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.",
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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

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.

PY - 2012/6/1

Y1 - 2012/6/1

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 - left main disease

KW - SYNTAX Score

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