Prediction of long-term patient outcome after contemporary left main stenting using the SYNTAX and SYNTAX II scores: A comparative analysis from the FAIL-II multicenter registry (failure in left main study with 2nd generation stents-Cardiogroup III study).
Aged
Aged, 80 and over
Coronary Angiography
Coronary Artery Disease
/ diagnostic imaging
Drug-Eluting Stents
Europe
Female
Humans
Male
Middle Aged
Percutaneous Coronary Intervention
/ adverse effects
Predictive Value of Tests
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
coronary artery disease (CAD)
left main coronary disease (LM)
stent, drug eluting (DES)
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
02
03
2019
revised:
24
07
2019
accepted:
17
08
2019
pubmed:
4
9
2019
medline:
9
2
2021
entrez:
4
9
2019
Statut:
ppublish
Résumé
To establish the value of the SYNTAX Score-II (SS-II) in predicting long-term mortality of patients treated with left main PCI (LM-PCI) using second-generation drug-eluting stents (DES). The SYNTAX score (SS) and the SS-II were calculated in 804 patients included in the FAILS-2 registry (failure in left main study with 2nd generation stents). Patients were classified in low (SS-II ≤33; n = 278, 34.6%), intermediate (SS-II 34-43; n = 260, 32.3%) and high (SS-II ≥44; n = 266, 33.1%) SS-II tertiles. Primary endpoint was all-cause mortality. A significant difference in long-term mortality was noted (5.2 ± 3.6 years): 4.1, 7.5, and 16.7% in low, mid and high SS-II tertiles respectively (p < .001). SS-II score was more accurate in predicting mortality than SS (AUC = 0.73; 95%CI: 0.67-0.79 vs. AUC = 0.55; 95%CI: 0.48-0.63, respectively; p < .001). SS-II led to a reclassification in the risk of all-cause mortality re-allocating 73% of patients from the CABG-only indication to PCI or equipoise PCI-or-CABG indication. Using multiple Cox regression analysis, SS-II (HR: 1.07; 95%CI: 1.05-1.09; p < .001), along with Acute coronary syndrome (ACS) (HR: 1.66; 95%CI: 1.03-2.66; p = .07) and Cardiogenic shock (CS) (HR: 2.82 (95%CI: 1.41-5.64; p = .003) were independent predictors of long-term mortality. SS-II (HR: 1.05; 95%CI: 1.04-1.06; p < .001) along with Insulin dependent Type 2 DM (HR: 1.58, 95%CI: 1.09-2.30.; p < .05), ACS (HR: 1.58, 95%CI: 1.16-2.14; p < .001) and CS (HR: 2.02 95%CI 1.16-3.53; p < .05), were independent predictors of long-term MACE. The SS-II was superior to the SS in predicting outcomes associated with contemporary LM-PCI. In this real-world population, two clinical variables not included in the SS-II, ACS and T2DM, were identified as additional markers of poor outcome.
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
E17-E26Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40:87-165.
Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines, and the American Association for Thoracic Surgery, preventive cardiovascular nurses association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130:1749-1767.
De Bruyne B, Fearon WF, Pijls NHJ, et al. Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med. 2014;371:1208-1217.
Iannaccone M, Quadri G, Taha S, et al. Prevalence and predictors of culprit plaque rupture at OCT in patients with coronary artery disease: a meta-analysis. Eur Heart J Cardiovasc Imaging. 2016;17:1128-1137.
D'Ascenzo F, Barbero U, Cerrato E, et al. Accuracy of intravascular ultrasound and optical coherence tomography in identifying functionally significant coronary stenosis according to vessel diameter: a meta-analysis of 2,581 patients and 2,807 lesions. Am Heart J. 2015;169:663-673.
D'Ascenzo F, Iannaccone M, Saint-Hilary G, et al. Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients. Eur Heart J. 2017;38:3160-3172.
Barbero U, Kanji R, Cerrato E, et al. Unprotected left Main coronary artery disease: outcomes of treatment with second-generation drug-eluting stents - insight from the FAILS-2 study. J Invasive Cardiol. 2018;30:283-288.
Mohr FW, Morice M-C, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013;381:629-638.
Farooq V, van Klaveren D, Steyerberg EW, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. 2013;381:639-650.
Escaned J, Collet C, Ryan N, et al. Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. Eur Heart J. 2017;38:3124-3134.
D'Ascenzo F, Chieffo A, Cerrato E, et al. Incidence and Management of Restenosis after Treatment of unprotected left Main disease with second-generation drug-eluting stents (from failure in left Main study with 2nd generation stents-Cardiogroup III study). Am J Cardiol. 2017;119:978-982.
Serruys PW, Morice M-C, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961-972.
Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation. 2012;126:2020-2035.
Pencina MJ, D'Agostino RB, D'Agostino RB, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2008;27:157-172. discussion 207-212.
R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2016.
Mangiacapra F, Maeng M, Cayla G, Lansky A, Meier P, Kolh P. EXCEL and NOBLE: stents or surgery for left main stem stenosis? EuroIntervention. 2017;13:e604-e608.
Yadav M, Palmerini T, Caixeta A, et al. Prediction of coronary risk by SYNTAX and derived scores: synergy between percutaneous coronary intervention with taxus and cardiac surgery. J Am Coll Cardiol. 2013;62:1219-1230.
Farooq V, Vergouwe Y, Räber L, et al. Combined anatomical and clinical factors for the long-term risk stratification of patients undergoing percutaneous coronary intervention: the logistic clinical SYNTAX score. Eur Heart J. 2012;33:3098-3104.
Song Y, Gao Z, Tang X, et al. Usefulness of the SYNTAX score II to validate 2-year outcomes in patients with complex coronary artery disease undergoing percutaneous coronary intervention: a large single-center study. Catheter Cardiovasc Interv. 2018;92(1):40-47. https://doi.org/10.1002/ccd.27321.
Janella BL, Campos CM, Caixeta A, et al. Assessment of long-term mortality in patients with complex coronary artery disease undergoing percutaneous intervention: comparison of multiple anatomical and clinical prognostic risk scores. EuroIntervention. 2017;13:1177-1184.
Garg S, Sarno G, Garcia-Garcia HM, et al. A new tool for the risk stratification of patients with complex coronary artery disease: the clinical SYNTAX score. Circ Cardiovasc Interv. 2010;3:317-326.
Girasis C, Garg S, Räber L, et al. SYNTAX score and clinical SYNTAX score as predictors of very long-term clinical outcomes in patients undergoing percutaneous coronary interventions: a substudy of SIRolimus-eluting stent compared with pacliTAXel-eluting stent for coronary revascularization (SIRTAX) trial. Eur Heart J. 2011;32:3115-3127.
Chieffo A, Meliga E, Latib A, et al. Drug-eluting stent for left main coronary artery disease. The DELTA registry: a multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment. JACC Cardiovasc Interv. 2012;5:718-727.
Campos CM, van Klaveren D, Iqbal J, et al. Predictive performance of SYNTAX score II in patients with left Main and multivessel coronary artery disease-analysis of CREDO-Kyoto registry. Circ J. 2014;78:1942-1949.
He J, Zhao H, Yu X, et al. SYNTAX score-II predicts long-term mortality in patients who underwent left Main percutaneous coronary intervention treated with second-generation drug-eluting stents. Int Heart J. 2017;58:344-350.
Campos CM, van Klaveren D, Farooq V, et al. Long-term forecasting and comparison of mortality in the evaluation of the Xience Everolimus eluting stent vs. coronary artery bypass surgery for effectiveness of left Main revascularization (EXCEL) trial: prospective validation of the SYNTAX score II. Eur Heart J. 2015;36:1231-1241.
Misumida N, Ahmed AE, Barlow M, et al. Prognostic value of anatomical SYNTAX score and SYNTAX score II in veterans with left Main and/or three-vessel coronary artery disease. Am J Cardiol. 2018;122:213-219.
Xu B, Généreux P, Yang Y, et al. Validation and comparison of the long-term prognostic capability of the SYNTAX score-II among 1,528 consecutive patients who underwent left main percutaneous coronary intervention. JACC Cardiovasc Interv. 2014;7:1128-1137.
Sotomi Y, Cavalcante R, van Klaveren D, et al. Individual long-term mortality prediction following either coronary stenting or bypass surgery in patients with multivessel and/or unprotected left Main disease: an external validation of the SYNTAX score II model in the 1,480 patients of the BEST and PRECOMBAT randomized controlled trials. JACC Cardiovasc Interv. 2016;9:1564-1572.
Obeid S, Frangieh AH, Räber L, et al. Prognostic value of SYNTAX score II in patients with acute coronary syndromes referred for invasive management: a subanalysis from the SPUM and COMFORTABLE AMI cohorts. Cardiol Res Pract. 2018;2018:9762176.
Salvatore A, Boukhris M, Giubilato S, et al. Usefulness of SYNTAX score II in complex percutaneous coronary interventions in the setting of acute coronary syndrome. J Saudi Heart Assoc. 2016;28:63-72.
Farooq V, Vergouwe Y, Généreux P, et al. Prediction of 1-year mortality in patients with acute coronary syndromes undergoing percutaneous coronary intervention: validation of the logistic clinical SYNTAX (synergy between percutaneous coronary interventions with Taxus and cardiac surgery) score. JACC Cardiovasc Interv. 2013;6:737-745.
Capodanno D, Giacoppo D, Dipasqua F, et al. Usefulness of the logistic clinical SYNTAX score for predicting 1-year mortality in patients undergoing percutaneous coronary intervention of the left main coronary artery. Catheter Cardiovasc Interv. 2013;82:E446-E452.
Cavalcante R, Sotomi Y, Mancone M, et al. Impact of the SYNTAX scores I and II in patients with diabetes and multivessel coronary disease: a pooled analysis of patient level data from the SYNTAX, PRECOMBAT, and BEST trials. Eur Heart J. 2017;38:1969-1977.
Mintz GS, Lefèvre T, Lassen JF, et al. Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the European bifurcation Club. EuroIntervention. 2018;14:e467-e474.
Cerrato E, Echavarria-Pinto M, D'Ascenzo F, et al. Safety of intermediate left main stenosis revascularization deferral based on fractional flow reserve and intravascular ultrasound: a systematic review and meta-regression including 908 deferred left main stenosis from 12 studies. Int J Cardiol. 2018;271:42-48.