TY - JOUR
T1 - Validation of the SYNTAX Revascularization Index to Quantify Reasonable Level of Incomplete Revascularization After Percutaneous Coronary Intervention
AU - Genereux, P
AU - Campos, CA
AU - Farooq, V
AU - Bektas, Fatma
AU - Mohr, FW
AU - Colombo, A
AU - Morel, Marie-Angele
AU - Feldman, TE
AU - Holmes, DR
AU - Mack, MJ
AU - Morice, MC
AU - Kappetein, Arie-Pieter
AU - Palmerini, T
AU - Stone, GW
AU - Serruys, PWJC (Patrick)
PY - 2015
Y1 - 2015
N2 - Incomplete revascularization is common after percutaneous coronary intervention (PCI). Whether a "reasonable" degree of incomplete revascularization is associated with a similar favorable long-term prognosis compared with complete revascularization remains unknown. We sought to quantify the proportion of coronary artery disease burden treated by PCI and evaluate its impact on outcomes using a new prognostic instrument the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) Revascularization Index (SRI). The baseline SYNTAX score (bSS), the residual SYNTAX score, and the delta SYNTAX score (Delta SS) were determined from 888 angiograms of patients enrolled in the prospective SYNTAX trial. The SRI was then calculated for each patient using the following formula: SRI = (Delta SS/bSS]) x 100. Outcomes were examined according to the proportion of revascularized myocardium (SRI = 100% [complete revascularization], 50% to <100%, and <50%). The Youden index for the SRI was computed to identify the best cutoff for 5-year all-cause mortality. The mean bSS was 28.4 +/- 11.5, and after PCI, the mean Delta SS was 23.8 +/- 10.9 and the mean residual SYNTAX score was 4.5 +/- 6.9. The mean SRI was 85.3 +/- 21.2% and was 100% in 385 patients (43.5%), <100% to 50% in 454 patients (51.1%), and <50% in 48 patients (5.4%). Five-year adverse outcomes, including death, were inversely proportional to the SRI. An SRI cutoff of <70% (present in 142 patients [16.0%] after PCI) had the best prognostic accuracy for prediction of death and, by multivariable analysis, was an independent predictor of 5-year mortality (hazard ratio [HR] 4.13, 95% confidence interval [CI] 2.79 to 6.11, p <0.0001). In conclusion, the SRI is a newly described method for quantifying the proportion of coronary artery disease burden treated by PCI. The SRI is a useful tool in assessing the degree of revascularization after PCI, with SRI 70% representing a "reasonable" goal for patients with complex coronary artery disease. (C) 2015 Elsevier Inc. All rights reserved.
AB - Incomplete revascularization is common after percutaneous coronary intervention (PCI). Whether a "reasonable" degree of incomplete revascularization is associated with a similar favorable long-term prognosis compared with complete revascularization remains unknown. We sought to quantify the proportion of coronary artery disease burden treated by PCI and evaluate its impact on outcomes using a new prognostic instrument the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) Revascularization Index (SRI). The baseline SYNTAX score (bSS), the residual SYNTAX score, and the delta SYNTAX score (Delta SS) were determined from 888 angiograms of patients enrolled in the prospective SYNTAX trial. The SRI was then calculated for each patient using the following formula: SRI = (Delta SS/bSS]) x 100. Outcomes were examined according to the proportion of revascularized myocardium (SRI = 100% [complete revascularization], 50% to <100%, and <50%). The Youden index for the SRI was computed to identify the best cutoff for 5-year all-cause mortality. The mean bSS was 28.4 +/- 11.5, and after PCI, the mean Delta SS was 23.8 +/- 10.9 and the mean residual SYNTAX score was 4.5 +/- 6.9. The mean SRI was 85.3 +/- 21.2% and was 100% in 385 patients (43.5%), <100% to 50% in 454 patients (51.1%), and <50% in 48 patients (5.4%). Five-year adverse outcomes, including death, were inversely proportional to the SRI. An SRI cutoff of <70% (present in 142 patients [16.0%] after PCI) had the best prognostic accuracy for prediction of death and, by multivariable analysis, was an independent predictor of 5-year mortality (hazard ratio [HR] 4.13, 95% confidence interval [CI] 2.79 to 6.11, p <0.0001). In conclusion, the SRI is a newly described method for quantifying the proportion of coronary artery disease burden treated by PCI. The SRI is a useful tool in assessing the degree of revascularization after PCI, with SRI 70% representing a "reasonable" goal for patients with complex coronary artery disease. (C) 2015 Elsevier Inc. All rights reserved.
U2 - 10.1016/j.amjcard.2015.03.056
DO - 10.1016/j.amjcard.2015.03.056
M3 - Article
C2 - 25983123
SN - 0002-9149
VL - 116
SP - 174
EP - 186
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 2
ER -