Angiographic complexity of coronary artery disease according to SYNTAX score and clinical outcomes after revascularisation with newer-generation drug-eluting stents: a substudy of the BIOSCIENCE trial

Abstract

Aims: We sought to assess the performance of drug-eluting stents combining an ultrathin cobalt-chromium platform with a biodegradable polymer across categories of increasing SYNTAX score (SS). Methods and results:Patients included in the BIOSCIENCE trial and randomly allocated to treatment with biodegradable polymer sirolimus-eluting stents (BP-SES) or durable polymer everolimus-eluting stents (DP-EES) were categorised according to SS tertiles (low <8, medium 8-15, high >15). The primary endpoint, target lesion failure (TLF), was defined as a composite of cardiac death, target vessel myocardial infarction and clinically indicated target lesion revascularisation. The patient-oriented endpoint (POCE) included death, myocardial infarction, or any repeat revascularisation. The SS was available in 2,041 out of 2,119 patients (96.3%). At two-year follow-up, patients with an SS >15 experienced higher rates of both TLF and POCE as compared to patients with medium and low SS (14.5% vs. 8.1% and vs. 5.9%, p<0.001; 22.7% vs. 14.9% and vs. 12.4%; p<0.001), respectively. Comparable rates of the composite endpoints were documented for both stent types in each category of SS.Conclusions: Increasing lesion complexity as assessed by SS was associated with higher rates of TLF and POCE in a contemporary PCI population with minimal exclusion criteria. BP-SES and DP-EES showed comparable performance across the entire spectrum of CAD severity. KEYWORDS• biodegradable polymer sirolimuseluting stents • coronary artery disease • durable polymer everolimus-eluting stents • SYNTAX score

Angiographic predictors of adverse outcomes after percutaneous coronary intervention in patients with radiation associated coronary artery disease

“…13,30,31 A sub analysis of the BIOSCIENCE trial using SESs showed 2-year rates of death, MI, or repeat revascularization of 14.5% in patients with SYNTAX score > 15 compared to 8.1% and 5.9% in two lower SYNTAX score comparators. 32 demonstrated the superiority of DES over BMS in de novo coronary disease with our data supporting similar findings in radiation induced coronary disease. [34][35][36] Few however have found an association with CV mortality.…”

“…Though the median score of 11 represents a relatively low SYNTAX score, worse outcomes with increasing score suggest XRT‐CAD shares similarities to de novo coronary disease consistent with the original derivation and validation of SYNTAX . A sub analysis of the BIOSCIENCE trial using SESs showed 2‐year rates of death, MI, or repeat revascularization of 14.5% in patients with SYNTAX score > 15 compared to 8.1% and 5.9% in two lower SYNTAX score comparators . Garg et al used SYNTAX score to compare results of the patients undergoing PCI with newer generation zotarolimus‐ or everolimus‐eluting stents in the RESOLUTE III Trial and found increased rates of a composite endpoint in patients with SS ≥ 17 compared with SS ≤ 9 .…”

Scaffold thrombosis following implantation of the ABSORB BVS in routine clinical practice: Insight into possible mechanisms from optical coherence tomography

“…In our current analysis, the number of uncovered scaffold struts in the (very) late ScT cases are comparable with the observed number of uncovered metallic stent strut. However, the number of malapposed struts seems to be higher in Absorb (6.0%) as in metallic stents (1.3%) .…”

Application of the SYNTAX score in interventional cardiology

“…Recently, the Synergy Between PCI With Taxus and CABG (SYNTAX) score was developed. [10] It is a tool which takes into consideration the anatomical features of the coronary lesions as a guide to assess patients who will be eligible for PCI. [11] …”