Impact of SYNTAX Score on 10-Year Outcomes After Revascularization for Left Main Coronary Artery Disease

Autor: Duk-Woo Park, Hanbit Park, Do-Yoon Kang, Seung-Whan Lee, Pil Hyung Lee, Jung-Min Ahn, Seung-Jung Park, Yong-Hoon Yoon, Sang-Cheol Cho, Seong-Wook Park
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Coronary Artery Disease
030204 cardiovascular system & hematology
Coronary Angiography
Revascularization
Risk Assessment
Severity of Illness Index
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Internal medicine
Republic of Korea
medicine
Humans
Registries
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Coronary Artery Bypass
Stroke
Aged
business.industry
Hazard ratio
Percutaneous coronary intervention
Middle Aged
medicine.disease
Coronary Vessels
Confidence interval
Cardiac surgery
Treatment Outcome
surgical procedures
operative
Conventional PCI
Cardiology
Female
Stents
Cardiology and Cardiovascular Medicine
business
Zdroj: JACC: Cardiovascular Interventions. 13:361-371
ISSN: 1936-8798
0279-1412
DOI: 10.1016/j.jcin.2019.10.020
Popis: Objectives The aim of this study was to investigate the long-term impact of SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SS) on differential outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) disease. Background The very long term prognostic effect of SS on mortality and major cardiovascular events after LMCA revascularization is still undetermined. Methods In the MAIN-COMPARE (Ten-Year Outcomes of Stents Versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease) registry, patients with baseline SS measurements were analyzed. The 10-year rates of all-cause mortality, the composite of death, Q-wave myocardial infarction, or stroke, and target vessel revascularization after PCI or CABG were compared according to baseline SS. Results Among 1,580 patients with baseline SS, 547 patients (34.6%) had low SS (≤22), 350 (22.2%) had intermediate SS (23 to 32), and 683 (43.2%) had high SS (≥33). In patients with low to intermediate SS, the adjusted 10-year risks for death and serious composite outcome were similar between the PCI group and the CABG group. However, in patients with high SS, PCI with stenting, compared with CABG, was associated with a higher risk for death (hazard ratio: 1.39; 95% confidence interval: 1.00 to 1.92; p = 0.048) and serious composite outcome (hazard ratio: 1.27; 95% confidence interval: 0.94 to 1.74; p = 0.123). In each revascularization group, conventional tertiles of SS had a differential prognostic impact on 10-year clinical outcomes in the PCI arm but not in the CABG arm. Conclusions In this 10-year extended follow-up of patients undergoing LMCA revascularization, CABG showed a clear prognostic benefit over PCI in patients with high anatomic complexity measured by SS at baseline. The discriminative capacity of SS on long-term outcomes was relevant in the PCI group but not in the CABG group. (Ten-Year Outcomes of Stents Versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease [MAIN-COMPARE]; NCT02791412)
Databáze: OpenAIRE
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