Angiographic outcomes following stenting or coronary artery bypass surgery of the left main coronary artery: Fifteen-month outcomes from the synergy between PCI with TAXUS express and cardiac surgery left main angiographic substudy (SYNTAX-LE MANS)

Marie Claude Morice, Ted E. Feldman, Michael J. Mack, Elisabeth Ståhle, David Holmes, Antonio Colombo, Marie Angèle Morel, Marcel Van Den Brand, Patrick W. Serruys, Friedrich Mohr, Didier Carrié, Gerard Fournial, Stefan James, Katrin Leadley, Keith D. Dawkins, A. Pieter Kappetein

Research output: Contribution to journalArticle

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Abstract

Aims: The SYNTAX-LE MANS substudy prospectively evaluated 15-month angiographic and clinical outcomes in patients with treated left main (LM) disease. Methods and results: In the SYNTAX trial, 1,800 patients with three-vessel and/or LM disease were randomised to either CABG or PCI; of these, 271 LM patients were prospectively assigned to receive a 15-month angiogram. The primary endpoint for the CABG arm was the ratio of ≥50% to <100% obstructed/occluded grafts bypassing LM lesions to the number placed. The primary endpoint for the PCI arm was the proportion of patients with ≤50% diameter stenosis ('patent' stents) of treated LM lesions. Per protocol, no formal comparison between CABG and PCI arms was intended based on the differing primary endpoints. Available 15-month angiograms were analysed for 114 CABG and 149 PCI patients. At 15 months, 9.9% (26/263) of CABG grafts were 100% occluded and an additional 5.7% (15/263) were ≥50% to <100% occluded. Overall, 27.2% (31/114) of patients had ≥1 obstructed/occluded graft. The 15-month CABG MACCE rate was 8.8% (10/114) and MACCE at 15 months was not significantly associated with graft obstruction/occlusion (p=0.85). In the PCI arm, 92.4% (134/145) of patients had ≤50% diameter LM stenosis at 15 months (89.7% [87/97] distal LM lesions and 97.9% [47/48] non-distal LM lesions). The 15-month PCI MACCE rate was 12.8% (20/156) and this was significantly associated with lack of stent patency at 15 months (p<0.001), mainly due to repeat revascularisation. Conclusions: At 15 months, 15.6% (41/263) of grafts were at least 50% obstructed but this was not significantly associated with MACCE; 92.4% (134/145) of patients had stents that remained patent at 15 months, and stent restenosis was significantly associated with MACCE, predominantly due to revascularisation.

Original languageEnglish (US)
Pages (from-to)670-679
Number of pages10
JournalEuroIntervention
Volume7
Issue number6
DOIs
StatePublished - Oct 1 2011

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Coronary Artery Bypass
Thoracic Surgery
Coronary Vessels
Stents
Transplants
Arm
Angiography
Pathologic Constriction

Keywords

  • Angiography
  • Bypass
  • Drug-eluting stent
  • Left main disease syntax

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Angiographic outcomes following stenting or coronary artery bypass surgery of the left main coronary artery : Fifteen-month outcomes from the synergy between PCI with TAXUS express and cardiac surgery left main angiographic substudy (SYNTAX-LE MANS). / Morice, Marie Claude; Feldman, Ted E.; Mack, Michael J.; Ståhle, Elisabeth; Holmes, David; Colombo, Antonio; Morel, Marie Angèle; Van Den Brand, Marcel; Serruys, Patrick W.; Mohr, Friedrich; Carrié, Didier; Fournial, Gerard; James, Stefan; Leadley, Katrin; Dawkins, Keith D.; Kappetein, A. Pieter.

In: EuroIntervention, Vol. 7, No. 6, 01.10.2011, p. 670-679.

Research output: Contribution to journalArticle

Morice, MC, Feldman, TE, Mack, MJ, Ståhle, E, Holmes, D, Colombo, A, Morel, MA, Van Den Brand, M, Serruys, PW, Mohr, F, Carrié, D, Fournial, G, James, S, Leadley, K, Dawkins, KD & Kappetein, AP 2011, 'Angiographic outcomes following stenting or coronary artery bypass surgery of the left main coronary artery: Fifteen-month outcomes from the synergy between PCI with TAXUS express and cardiac surgery left main angiographic substudy (SYNTAX-LE MANS)', EuroIntervention, vol. 7, no. 6, pp. 670-679. https://doi.org/10.4244/EIJV7I6A109
Morice, Marie Claude ; Feldman, Ted E. ; Mack, Michael J. ; Ståhle, Elisabeth ; Holmes, David ; Colombo, Antonio ; Morel, Marie Angèle ; Van Den Brand, Marcel ; Serruys, Patrick W. ; Mohr, Friedrich ; Carrié, Didier ; Fournial, Gerard ; James, Stefan ; Leadley, Katrin ; Dawkins, Keith D. ; Kappetein, A. Pieter. / Angiographic outcomes following stenting or coronary artery bypass surgery of the left main coronary artery : Fifteen-month outcomes from the synergy between PCI with TAXUS express and cardiac surgery left main angiographic substudy (SYNTAX-LE MANS). In: EuroIntervention. 2011 ; Vol. 7, No. 6. pp. 670-679.
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abstract = "Aims: The SYNTAX-LE MANS substudy prospectively evaluated 15-month angiographic and clinical outcomes in patients with treated left main (LM) disease. Methods and results: In the SYNTAX trial, 1,800 patients with three-vessel and/or LM disease were randomised to either CABG or PCI; of these, 271 LM patients were prospectively assigned to receive a 15-month angiogram. The primary endpoint for the CABG arm was the ratio of ≥50{\%} to <100{\%} obstructed/occluded grafts bypassing LM lesions to the number placed. The primary endpoint for the PCI arm was the proportion of patients with ≤50{\%} diameter stenosis ('patent' stents) of treated LM lesions. Per protocol, no formal comparison between CABG and PCI arms was intended based on the differing primary endpoints. Available 15-month angiograms were analysed for 114 CABG and 149 PCI patients. At 15 months, 9.9{\%} (26/263) of CABG grafts were 100{\%} occluded and an additional 5.7{\%} (15/263) were ≥50{\%} to <100{\%} occluded. Overall, 27.2{\%} (31/114) of patients had ≥1 obstructed/occluded graft. The 15-month CABG MACCE rate was 8.8{\%} (10/114) and MACCE at 15 months was not significantly associated with graft obstruction/occlusion (p=0.85). In the PCI arm, 92.4{\%} (134/145) of patients had ≤50{\%} diameter LM stenosis at 15 months (89.7{\%} [87/97] distal LM lesions and 97.9{\%} [47/48] non-distal LM lesions). The 15-month PCI MACCE rate was 12.8{\%} (20/156) and this was significantly associated with lack of stent patency at 15 months (p<0.001), mainly due to repeat revascularisation. Conclusions: At 15 months, 15.6{\%} (41/263) of grafts were at least 50{\%} obstructed but this was not significantly associated with MACCE; 92.4{\%} (134/145) of patients had stents that remained patent at 15 months, and stent restenosis was significantly associated with MACCE, predominantly due to revascularisation.",
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T1 - Angiographic outcomes following stenting or coronary artery bypass surgery of the left main coronary artery

T2 - Fifteen-month outcomes from the synergy between PCI with TAXUS express and cardiac surgery left main angiographic substudy (SYNTAX-LE MANS)

AU - Morice, Marie Claude

AU - Feldman, Ted E.

AU - Mack, Michael J.

AU - Ståhle, Elisabeth

AU - Holmes, David

AU - Colombo, Antonio

AU - Morel, Marie Angèle

AU - Van Den Brand, Marcel

AU - Serruys, Patrick W.

AU - Mohr, Friedrich

AU - Carrié, Didier

AU - Fournial, Gerard

AU - James, Stefan

AU - Leadley, Katrin

AU - Dawkins, Keith D.

AU - Kappetein, A. Pieter

PY - 2011/10/1

Y1 - 2011/10/1

N2 - Aims: The SYNTAX-LE MANS substudy prospectively evaluated 15-month angiographic and clinical outcomes in patients with treated left main (LM) disease. Methods and results: In the SYNTAX trial, 1,800 patients with three-vessel and/or LM disease were randomised to either CABG or PCI; of these, 271 LM patients were prospectively assigned to receive a 15-month angiogram. The primary endpoint for the CABG arm was the ratio of ≥50% to <100% obstructed/occluded grafts bypassing LM lesions to the number placed. The primary endpoint for the PCI arm was the proportion of patients with ≤50% diameter stenosis ('patent' stents) of treated LM lesions. Per protocol, no formal comparison between CABG and PCI arms was intended based on the differing primary endpoints. Available 15-month angiograms were analysed for 114 CABG and 149 PCI patients. At 15 months, 9.9% (26/263) of CABG grafts were 100% occluded and an additional 5.7% (15/263) were ≥50% to <100% occluded. Overall, 27.2% (31/114) of patients had ≥1 obstructed/occluded graft. The 15-month CABG MACCE rate was 8.8% (10/114) and MACCE at 15 months was not significantly associated with graft obstruction/occlusion (p=0.85). In the PCI arm, 92.4% (134/145) of patients had ≤50% diameter LM stenosis at 15 months (89.7% [87/97] distal LM lesions and 97.9% [47/48] non-distal LM lesions). The 15-month PCI MACCE rate was 12.8% (20/156) and this was significantly associated with lack of stent patency at 15 months (p<0.001), mainly due to repeat revascularisation. Conclusions: At 15 months, 15.6% (41/263) of grafts were at least 50% obstructed but this was not significantly associated with MACCE; 92.4% (134/145) of patients had stents that remained patent at 15 months, and stent restenosis was significantly associated with MACCE, predominantly due to revascularisation.

AB - Aims: The SYNTAX-LE MANS substudy prospectively evaluated 15-month angiographic and clinical outcomes in patients with treated left main (LM) disease. Methods and results: In the SYNTAX trial, 1,800 patients with three-vessel and/or LM disease were randomised to either CABG or PCI; of these, 271 LM patients were prospectively assigned to receive a 15-month angiogram. The primary endpoint for the CABG arm was the ratio of ≥50% to <100% obstructed/occluded grafts bypassing LM lesions to the number placed. The primary endpoint for the PCI arm was the proportion of patients with ≤50% diameter stenosis ('patent' stents) of treated LM lesions. Per protocol, no formal comparison between CABG and PCI arms was intended based on the differing primary endpoints. Available 15-month angiograms were analysed for 114 CABG and 149 PCI patients. At 15 months, 9.9% (26/263) of CABG grafts were 100% occluded and an additional 5.7% (15/263) were ≥50% to <100% occluded. Overall, 27.2% (31/114) of patients had ≥1 obstructed/occluded graft. The 15-month CABG MACCE rate was 8.8% (10/114) and MACCE at 15 months was not significantly associated with graft obstruction/occlusion (p=0.85). In the PCI arm, 92.4% (134/145) of patients had ≤50% diameter LM stenosis at 15 months (89.7% [87/97] distal LM lesions and 97.9% [47/48] non-distal LM lesions). The 15-month PCI MACCE rate was 12.8% (20/156) and this was significantly associated with lack of stent patency at 15 months (p<0.001), mainly due to repeat revascularisation. Conclusions: At 15 months, 15.6% (41/263) of grafts were at least 50% obstructed but this was not significantly associated with MACCE; 92.4% (134/145) of patients had stents that remained patent at 15 months, and stent restenosis was significantly associated with MACCE, predominantly due to revascularisation.

KW - Angiography

KW - Bypass

KW - Drug-eluting stent

KW - Left main disease syntax

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