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 The SYNTAX Trial at 3 Years

PWJC (Patrick) Serruys, V Farooq, Pascal Vranckx, Chrysafios Girasis, S Brugaletta, HM Garcia-Garcia, DR Holmes, Arie-Pieter Kappetein, MJ Mack, T Feldman, MC Morice, E Stahle, S James, A Colombo, P Pereda, J Huang, Marie-Angele Morel, Gerrit-anne Es, KD Dawkins, FW MohrEwout Steyerberg

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Abstract

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 signifi 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. (J Am Coll Cardiol Intv 2012;5:606-17) (c) 2012 by the American College of Cardiology Foundation
Original languageUndefined/Unknown
Pages (from-to)606-617
Number of pages12
JournalJACC-Cardiovascular interventions
Volume5
Issue number6
DOIs
Publication statusPublished - 2012

Research programs

  • EMC COEUR-09
  • EMC NIHES-02-65-01

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