SYNTAX Score and Long-Term Outcomes: The BARI-2D Trial

Fumiaki Ikeno, Maria Mori Brooks, Kaori Nakagawa, Min Kyu Kim, Hideaki Kaneda, Yoshiaki Mitsutake, Helen A. Vlachos, Leonard Schwartz, Robert L. Frye, Sheryl F. Kelsey, Katsuhisa Waseda, Mark A. Hlatky, Katherine M. Detre, Trevor J. Orchard, Stephen B. Thomas, Kim Sutton Tyrrell, Jamal S. Rana, Frani Averbach, Joan M. MacGregor, Scott M. O'NealKathleen Pitluga, Veronica Sansing, Mary Tranchine, Sharon W. Crow, Marianne (Marnie) Bertolet, Regina Hardison, Kevin Kip, Manuel Lombardero, Jiang Lu, Sue Janiszewski, Darina Protivnak, Sarah Reiser, Stephen Barton, Ping Guo, Yulia Kushner, Owen Michael, Jeffrey P. Martin, Christopher Kania, Michael Kania, Jeffrey O'Donnell, Rae Ann Maxwell, Suzanne Goldberg, Yves Rosenberg, Patrice Desvigne-Nickens, Abby Ershow, David Gordon, Dina Paltoo, Teresa L.Z. Jones, Whady Hueb, José Ramires, Neuza Lopes, Bernardo Léo Wajchenberg, Eulogio E. Martinez, Sergio A. Oliveira, Expedito E. Ribeiro, Marcos Perin, Roberto Betti, George Steiner, Alan Barolet, Yolanda Groenewoud, Lisa Mighton, Kathy Camelon, Robert O'Rourke, Janet Blodgett, Edward Sako, Judith Nicastro, Robin Prescott, Charanjit Rihal, Frank Kennedy, Gregory Barsness, Amanda Basu, Alfredo Clavell, David R. Holmes, Amir Lerman, Charles Mullaney, Guy Reeder, Robert Rizza, Hartzell Schaff, Steven Smith, Virend Somers, Thoralf Sundt, Henry Ting, R. Scott Wright, Pam Helgemoe, Diane Lesmeister, Deborah Rolbiecki, Luis Lepe-Montoya, Jorge Escobedo, Rafael Barraza, Rubén Baleón, Arturo Campos, Paula García, Carlos Lezama, Carlos Miramontes, Salvador Ocampo, Joaquín V. Peñafiel, Aquiles Valdespino, Raúl Verdín, Héctor Albarrán, Fernando Ayala, Eduardo Chávez, Héctor Murillo, Luisa Virginia Buitrón, Beatriz Rico-Verdin, Fabiola Angulo, Dale Adler, Austin Arthur Halle, Faramarz Ismail-Beigi, Suvinay Paranjape, Stacey Mazzurco, Karen Ridley, Kodangudi Ramanathan, Solomon Solomon, Barry Wall, Darryl Weinman, Tammy Touchstone, Lillie Douglas, Martial Bourassa, Jean Claude Tardif, Jean Louis Chiasson, Marc Andre Lavoie, Rémi Rabasa-Lhoret, Hélène Langelier, Suzy Foucher, Johanne Trudel, Scott Monrad, Vankeepuram Srinivas, Joel Zonszein, Jill Crandall, Helena Duffy, Eugen Vartolomei, Spencer King, Carl Jacobs, David Robertson, Marty Porter, Melanie Eley, Emmalee Nichols, Jennifer LaCorte, Melinda Mock, William Rogers, Fernando Ovalle, David Bell, Vijay K. Misra, William B. Hillegass, Raed Aqel, Penny Pierce, Melanie Smith, Leah Saag, Ashley Vaughn, Dwight Smith, Tiffany Grimes, Susan Rolli, Roberta Hill, Beth Dean Barrett, Clarinda Morehead, Ken Doss, Charles J. Davidson, Mark Molitch, Nirat Beohar, Elaine Massaro, Lynne Goodreau, Fabiola Arroyo, Petr Neužil, Lenka Pavlickova, Štĕpánka Stehlíková, Jaroslav Benedik, Liz Coling, Richard Davies, Christopher Glover, Michel LeMay, Thierry Mesana, Teik Chye Ooi, Mark Silverman, Alexander Sorisky, Colette Favreau, Susan McClinton, Melvin Weiss, Irene Weiss, Leo Saulle, Harichandra Kannam, Joanne C. Kurylas, Lorraine Vasi, John Douglas, Ziyad Ghazzal, Laurence Sperling, Priya Dayamani, Suzanne Gebhart, Sabreena Basu, Tarek Helmy, Vin Tangpricha, Pamela Hyde, Margaret Jenkins, Barbara P. Grant, Kenneth Kent, William Suddath, Michelle Magee, Patricia Julien-Williams, Vida Reed, Carine Nassar, Gilles Dagenais, Claude Garceau, Dominique Auger, Christopher Buller, Tom Elliott, Krishnan Ramanathan, Donald Ricci, Rebecca Fox, Daniela Kolesniak, Michael Attubato, Frederick Feit, Stephen Richardson, Ivan Pena Sing, James Slater, Angela Amendola, Bernardo Vargas, Nicholas Tsapatsaris, Bartholomew Woods, Gary Cushing, Martin Rutter, Premranjan Singh, Gail DesRochers, Gail Woodhead, Deborah Gannon, Nancy Shinopulos Campbell, Michael Ragosta, Ian Sarembock, Eric Powers, Eugene Barrett, Linda Jahn, Karen Murie, Gladwin Das, Gardar Sigurdsson, Carl White, John Bantle, J. Bruce Redmon, Christine Kwong, Jacqueline Tamis-Holland, Jeanine Albu, Judith S. Hochman, James Wilentz, Sylvaine Frances, Deborah Tormey, Carl Pepine, Karen Smith, Laurence Kennedy, Karen Brezner, Tempa Curry, Frank Bleyer, Stewart Albert, Arshag Mooradian, Sharon Plummer, Francisco Fuentes, Roberto Robles, Victor Lavis, Jaime Gomez, Cesar Iliescu, Carol Underwood, Maria Selin Fulton, Julie Gomez Ramirez, Jennifer Merta, Glenna Scott, Ashok Krishnaswami, Lynn Dowdell, Sarah Berkheimer, Adam Greenbaum, Fred Whitehouse, Raquel Pangilinan, Kelly Mann, Alice K. Jacobs, Elliot Sternthal, Susana Ebner, Zoran Nedeljkovic, Paula Beardsley, David Schneider, Richard Pratley, William Cefalu, Joel Schnure, Michaelanne Rowen, Linda Tilton, Alan Niederman, Cristina Mata, Terri Kellerman, John Farmer, Alan J. Garber, Neal Kleiman, Nancy Howard, Debra Nichols, Madonna Pool, Christopher Granger, Mark Feinglos, George Adams, Jennifer Green, Bernadette Druken, Dani Underwood, J. Lawrence Stafford, Thomas Donner, Warren Laskey, Dana Beach, John Lopez, Andrew Davis, David Faxon, Sirimon Reutrakul, Emily Bayer, Oscar Marroquin, Howard Cohen, Mary Korytkowski, Glory Koerbel, Lisa Baxendell, Debbie Rosenfelder, Louise DeRiso, Carole Farrell, Tina Vita, Janet McGill, Ronald Krone, Richard Bach, Carol Recklein, Kristin M. Luepke, Mary Jane Clifton, Michael E. Farkouh, Michael C. Kim, Donald A. Smith, Ida Guzman, Arlene Travis, James O'Keefe, Alan Forker, William Isley, Richard Moe, Paul Kennedy, Margaret Rosson, Aimee Long, Eric Bates, William Herman, Rodica Pop-Busui, Claire Duvernoy, Martin Stevens, Ann Luciano, Cheryl Majors, Sheldon H. Gottlieb, Annabelle Rodriguez, Melanie Herr, David Williams, Robert J. Smith, J. Dawn Abbott, Marc J. Laufgraben, Mary Grogan, Janice Muratori, Gabriel Habib, Marco Marcelli, Issam Mikati, Emilia Cordero, Gina Caldwell, David Schechter, Daniel Lorber, Phyllis August, Maisie Brown, Patricia Depree, Kurt Huber, Ursula Hanusch-Enserer, Nelly Jordanova, Dilek Cilesiz, Birgit Vogel, Ben McCallister, Michael Kleerekoper, Kelly Mandagere, Robert Urbanic, James Bengston, Bobby K. Kong, Andrew Pruitt, Jeffrey Sanfield, Carol Carulli, Ruth Churley-Strom, Raymond Magorien, Kwame Osei, Cecilia Casey Boyer, Richard Lee, Pasquale Palumbo, Joyce Wisbey, Edwin Alderman, Anne Schwarzkopf Michael Steffes, Maren Nowicki, Jean Bucksa, Bernard Chaitman, Jane Eckstein, Karen Stocke, Derek B. Boothroyd, Kathryn A. Melsop, Burton E. Sobel, Dagnija Neimane, Ami E. Iskandrian, Mary Beth Schaaf, Saul Genuth, Theresa Bongarno, Richard Nesto, Karen Hultberg, Helene Rosenhouse-Romeo, Georgia Pambianco, Michael Mock, Thomas Ryan, Harold Lebovitz, Robert Brown, Gottlieb Friesinger, Edward Horton, Jay Mason, Renu Virmani, Lawrence Wechsler, C. Noel Bairey-Merz, J. Ward Kennedy, Elliott Antman, John Colwell, Sarah Fowler, Curt Furberg, Lee Goldman, Bruce Jennings, Scott Rankin

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

Background The extent of coronary disease affects clinical outcomes and may predict the effectiveness of coronary revascularization with either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score quantifies the extent of coronary disease. Objectives This study sought to determine whether SYNTAX scores predicted outcomes and the effectiveness of coronary revascularization compared with medical therapy in the BARI-2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial. Methods Baseline SYNTAX scores were retrospectively calculated for BARI-2D patients without prior revascularization (N = 1,550) by angiographic laboratory investigators masked to patient characteristics and outcomes. The primary outcome was major cardiovascular events (a composite of death, myocardial infarction, and stroke) over 5 years. Results A mid/high SYNTAX score (≥23) was associated with a higher risk of major cardiovascular events (hazard ratio: 1.36, confidence interval: 1.07 to 1.75, p = 0.01). Patients in the CABG stratum had significantly higher SYNTAX scores: 36% had mid/high SYNTAX scores compared with 13% in the PCI stratum (p < 0.001). Among patients with low SYNTAX scores (≤22), major cardiovascular events did not differ significantly between revascularization and medical therapy, either in the CABG stratum (26.1% vs. 29.9%, p = 0.41) or in the PCI stratum (17.8% vs. 19.2%, p = 0.84). Among patients with mid/high SYNTAX scores, however, major cardiovascular events were lower after revascularization than with medical therapy in the CABG stratum (15.3% vs. 30.3%, p = 0.02), but not in the PCI stratum (35.6% vs. 26.5%, p = 0.12). Conclusions Among patients with diabetes and stable ischemic heart disease, higher SYNTAX scores predict higher rates of major cardiovascular events and were associated with more favorable outcomes of revascularization compared with medical therapy among patients suitable for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes; NCT00006305)

Original languageEnglish (US)
Pages (from-to)395-403
Number of pages9
JournalJournal of the American College of Cardiology
Volume69
Issue number4
DOIs
StatePublished - Jan 31 2017

Keywords

  • angiography
  • coronary disease
  • ischemia
  • prognosis
  • stents
  • surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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