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.
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 - SYNTAX Score
KW - left main disease
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UR - http://www.scopus.com/inward/citedby.url?scp=84862892413&partnerID=8YFLogxK
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 -