Complex coronary anatomy in coronary artery bypass graft surgery: Impact of complex coronary anatomy in modern bypass surgery? Lessons learned from the SYNTAX trial after two years

Friedrich W. Mohr, Ardawan J. Rastan, Patrick W. Serruys, A. Pieter Kappetein, David Holmes, Jose L. Pomar, Stephen Westaby, Katrin Leadley, Keith D. Dawkins, Michael J. MacK

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Objective: SYNTAX study compares outcomes of coronary artery bypass grafting with percutaneous coronary intervention in patients with 3-vessel and/or left main disease. Complexity of coronary artery disease was quantified by the SYNTAX score, which combines anatomic characteristics of each significant lesion. This study aims to clarify whether SYNTAX score affects the outcome of bypass grafting as defined by major adverse cerebrovascular and cardiac events (MACCE) and its components over a 2-year follow-up period. Methods: Of the 3075 patients enrolled in SYNTAX, 1541 underwent coronary artery bypass grafting (897 randomized controlled trial patients, and 644 registry patients). All patients undergoing bypass grafting were stratified according to their SYNTAX score into 3 tertiles: low (0-22), intermediate (22-32), and high (≥33) complexity. Clinical outcomes up to 2 years after allocation were determined for each group and further risk factor analysis was performed. Results: Registry patients had more complex disease than those in the randomized controlled trial (SYNTAX score: registry 37.8 ± 13.3 vs randomized 29.1 ± 11.4; P < .001). At 30 days, overall coronary bypass mortality was 0.9% (registry 0.6% vs randomized 1.2%). MACCE rate at 30 days was 4.4% (registry 3.4% vs randomized 5.2%). SYNTAX score did not significantly affect overall 2-year MACCE rate of 15.6% for low, 14.3% for medium, and 15.4% for high SYNTAX scores. Compared with randomized patients, registry patients had a lower rate of overall MACCE rate (registry 13.0% vs randomized 16.7%; P = .046) and repeat revascularization (4.7% vs 8.6%; P = .003), whereas other event rates were comparable. Risk factor analysis revealed left main disease (P = .049) and incomplete revascularization (P = .005) as predictive for adverse 2-year outcomes. Conclusions: The outcome of coronary artery bypass grafting was excellent and independent from the SYNTAX score. Incomplete revascularization rather than degree of coronary complexity adversely affects late outcomes of coronary bypass.

Original languageEnglish (US)
Pages (from-to)130-140
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume141
Issue number1
DOIs
StatePublished - Jan 1 2011

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Coronary Artery Bypass
Anatomy
Registries
Transplants
Statistical Factor Analysis
Randomized Controlled Trials
Percutaneous Coronary Intervention
Coronary Artery Disease
Outcome Assessment (Health Care)
Mortality

Keywords

  • CABG
  • cerebrovascular accident
  • coronary artery bypass grafting
  • CVA
  • internal thoracic artery
  • ITA
  • LAD
  • left anterior descending coronary artery
  • left main
  • LM
  • MACCE
  • major adverse cardiac and cerebrovascular event
  • MI
  • myocardial infarction
  • OUS
  • outside the United States
  • PCI
  • percutaneous coronary intervention
  • SYNergy between PCI with TAXUS and Cardiac Surgery
  • SYNTAX
  • United States
  • US
  • VD
  • vessel disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Complex coronary anatomy in coronary artery bypass graft surgery : Impact of complex coronary anatomy in modern bypass surgery? Lessons learned from the SYNTAX trial after two years. / Mohr, Friedrich W.; Rastan, Ardawan J.; Serruys, Patrick W.; Kappetein, A. Pieter; Holmes, David; Pomar, Jose L.; Westaby, Stephen; Leadley, Katrin; Dawkins, Keith D.; MacK, Michael J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 141, No. 1, 01.01.2011, p. 130-140.

Research output: Contribution to journalArticle

Mohr, Friedrich W. ; Rastan, Ardawan J. ; Serruys, Patrick W. ; Kappetein, A. Pieter ; Holmes, David ; Pomar, Jose L. ; Westaby, Stephen ; Leadley, Katrin ; Dawkins, Keith D. ; MacK, Michael J. / Complex coronary anatomy in coronary artery bypass graft surgery : Impact of complex coronary anatomy in modern bypass surgery? Lessons learned from the SYNTAX trial after two years. In: Journal of Thoracic and Cardiovascular Surgery. 2011 ; Vol. 141, No. 1. pp. 130-140.
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abstract = "Objective: SYNTAX study compares outcomes of coronary artery bypass grafting with percutaneous coronary intervention in patients with 3-vessel and/or left main disease. Complexity of coronary artery disease was quantified by the SYNTAX score, which combines anatomic characteristics of each significant lesion. This study aims to clarify whether SYNTAX score affects the outcome of bypass grafting as defined by major adverse cerebrovascular and cardiac events (MACCE) and its components over a 2-year follow-up period. Methods: Of the 3075 patients enrolled in SYNTAX, 1541 underwent coronary artery bypass grafting (897 randomized controlled trial patients, and 644 registry patients). All patients undergoing bypass grafting were stratified according to their SYNTAX score into 3 tertiles: low (0-22), intermediate (22-32), and high (≥33) complexity. Clinical outcomes up to 2 years after allocation were determined for each group and further risk factor analysis was performed. Results: Registry patients had more complex disease than those in the randomized controlled trial (SYNTAX score: registry 37.8 ± 13.3 vs randomized 29.1 ± 11.4; P < .001). At 30 days, overall coronary bypass mortality was 0.9{\%} (registry 0.6{\%} vs randomized 1.2{\%}). MACCE rate at 30 days was 4.4{\%} (registry 3.4{\%} vs randomized 5.2{\%}). SYNTAX score did not significantly affect overall 2-year MACCE rate of 15.6{\%} for low, 14.3{\%} for medium, and 15.4{\%} for high SYNTAX scores. Compared with randomized patients, registry patients had a lower rate of overall MACCE rate (registry 13.0{\%} vs randomized 16.7{\%}; P = .046) and repeat revascularization (4.7{\%} vs 8.6{\%}; P = .003), whereas other event rates were comparable. Risk factor analysis revealed left main disease (P = .049) and incomplete revascularization (P = .005) as predictive for adverse 2-year outcomes. Conclusions: The outcome of coronary artery bypass grafting was excellent and independent from the SYNTAX score. Incomplete revascularization rather than degree of coronary complexity adversely affects late outcomes of coronary bypass.",
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T2 - Impact of complex coronary anatomy in modern bypass surgery? Lessons learned from the SYNTAX trial after two years

AU - Mohr, Friedrich W.

AU - Rastan, Ardawan J.

AU - Serruys, Patrick W.

AU - Kappetein, A. Pieter

AU - Holmes, David

AU - Pomar, Jose L.

AU - Westaby, Stephen

AU - Leadley, Katrin

AU - Dawkins, Keith D.

AU - MacK, Michael J.

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Objective: SYNTAX study compares outcomes of coronary artery bypass grafting with percutaneous coronary intervention in patients with 3-vessel and/or left main disease. Complexity of coronary artery disease was quantified by the SYNTAX score, which combines anatomic characteristics of each significant lesion. This study aims to clarify whether SYNTAX score affects the outcome of bypass grafting as defined by major adverse cerebrovascular and cardiac events (MACCE) and its components over a 2-year follow-up period. Methods: Of the 3075 patients enrolled in SYNTAX, 1541 underwent coronary artery bypass grafting (897 randomized controlled trial patients, and 644 registry patients). All patients undergoing bypass grafting were stratified according to their SYNTAX score into 3 tertiles: low (0-22), intermediate (22-32), and high (≥33) complexity. Clinical outcomes up to 2 years after allocation were determined for each group and further risk factor analysis was performed. Results: Registry patients had more complex disease than those in the randomized controlled trial (SYNTAX score: registry 37.8 ± 13.3 vs randomized 29.1 ± 11.4; P < .001). At 30 days, overall coronary bypass mortality was 0.9% (registry 0.6% vs randomized 1.2%). MACCE rate at 30 days was 4.4% (registry 3.4% vs randomized 5.2%). SYNTAX score did not significantly affect overall 2-year MACCE rate of 15.6% for low, 14.3% for medium, and 15.4% for high SYNTAX scores. Compared with randomized patients, registry patients had a lower rate of overall MACCE rate (registry 13.0% vs randomized 16.7%; P = .046) and repeat revascularization (4.7% vs 8.6%; P = .003), whereas other event rates were comparable. Risk factor analysis revealed left main disease (P = .049) and incomplete revascularization (P = .005) as predictive for adverse 2-year outcomes. Conclusions: The outcome of coronary artery bypass grafting was excellent and independent from the SYNTAX score. Incomplete revascularization rather than degree of coronary complexity adversely affects late outcomes of coronary bypass.

AB - Objective: SYNTAX study compares outcomes of coronary artery bypass grafting with percutaneous coronary intervention in patients with 3-vessel and/or left main disease. Complexity of coronary artery disease was quantified by the SYNTAX score, which combines anatomic characteristics of each significant lesion. This study aims to clarify whether SYNTAX score affects the outcome of bypass grafting as defined by major adverse cerebrovascular and cardiac events (MACCE) and its components over a 2-year follow-up period. Methods: Of the 3075 patients enrolled in SYNTAX, 1541 underwent coronary artery bypass grafting (897 randomized controlled trial patients, and 644 registry patients). All patients undergoing bypass grafting were stratified according to their SYNTAX score into 3 tertiles: low (0-22), intermediate (22-32), and high (≥33) complexity. Clinical outcomes up to 2 years after allocation were determined for each group and further risk factor analysis was performed. Results: Registry patients had more complex disease than those in the randomized controlled trial (SYNTAX score: registry 37.8 ± 13.3 vs randomized 29.1 ± 11.4; P < .001). At 30 days, overall coronary bypass mortality was 0.9% (registry 0.6% vs randomized 1.2%). MACCE rate at 30 days was 4.4% (registry 3.4% vs randomized 5.2%). SYNTAX score did not significantly affect overall 2-year MACCE rate of 15.6% for low, 14.3% for medium, and 15.4% for high SYNTAX scores. Compared with randomized patients, registry patients had a lower rate of overall MACCE rate (registry 13.0% vs randomized 16.7%; P = .046) and repeat revascularization (4.7% vs 8.6%; P = .003), whereas other event rates were comparable. Risk factor analysis revealed left main disease (P = .049) and incomplete revascularization (P = .005) as predictive for adverse 2-year outcomes. Conclusions: The outcome of coronary artery bypass grafting was excellent and independent from the SYNTAX score. Incomplete revascularization rather than degree of coronary complexity adversely affects late outcomes of coronary bypass.

KW - CABG

KW - cerebrovascular accident

KW - coronary artery bypass grafting

KW - CVA

KW - internal thoracic artery

KW - ITA

KW - LAD

KW - left anterior descending coronary artery

KW - left main

KW - LM

KW - MACCE

KW - major adverse cardiac and cerebrovascular event

KW - MI

KW - myocardial infarction

KW - OUS

KW - outside the United States

KW - PCI

KW - percutaneous coronary intervention

KW - SYNergy between PCI with TAXUS and Cardiac Surgery

KW - SYNTAX

KW - United States

KW - US

KW - VD

KW - vessel disease

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