Can We Improve the Outcomes of Multivessel Disease Using Modified SYNTAX and Residual SYNTAX Scores?

Rodríguez, Alfredo E.; Fernández‐Pereira, Carlos; Mieres, Juan; Mendoza, Javier; Sartori, F

doi:10.1007/s11886-017-0833-2

Cited by 7 publications

(12 citation statements)

References 35 publications

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“…Recently, ERACI IV investigators reported that a conservative strategy during DES deployment was associated with a low number of adverse events at follow up. Moreover, they found that residual risk score built following such PCI strategy, had more correlation with the late outcome that the original residual Syntax score has had 19,24 . Accordingly, in the present study, we also found large discrepancies in baseline and residual risk score between both methods of measurements, however, we don't know if the above benefits would also be present in patients treated with BMS design.…”

Section: Discussionmentioning

confidence: 99%

In Hospital and 30 Days Results of the Prospective, Observational, Multicenter and Controlled “real world” WALTZ Registry

Lloberas¹,

Iravedra²,

Haeik³

et al. 2017

RACI

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Purpose: To evaluate and describe in-hospital and 30 days clinical outcomes in a real world population treated with a new BMS design and with multiple vessel disease and/or left main coronary artery disease (CAD). Methods: Since August 2016 to March 2017, 201 consecutive patients undergoing coronary stent implantation in 12 centers in Argentina were included in our registry. Multiple vessel disease and/or unprotected left main disease, acute coronary syndromes , including ST elevation myocardial infarction (MI) and coronary arteries with 70% or more of diameter stenosis, were inclusion criteria. On the other hand, in-stent restenosis, protected left main stenosis or impossibility to receive double antiplatelet therapy for at least one month constitute the exclusion criteria. Primary endpoint was hard clinical end points, defined as any cause of death, MI or cerebrovascular accident. Major adverse cardiac events (MACE) are defined as the incidence of cardiac death, MI, and any ischemic driven lesion revascularization (TLR). Incidence of definitive and possible stent thrombosis (SET) was also analyzed. Baseline and residual Syntax and ERACI score risks were analyzed and compared. Results: The average age was 61.5 +/-12 years, 80.1% were men, with a 31.3% of known coronary artery disease and 24.4% with history of MI. The 67.2% of patients had an ACS, of which 31.8% had ST elevation MI. 46.8% of patients had multiple vessel disease and 1.34 vessels per patient were treated in the index procedure. Dual antiplatelet therapy was used in 100% of patients, 52.3% received clopidogrel as charging dose, 11.4% of prasugrel and 36.3% ticagrelor as preferred thyenopiridines. 30 days MACE was 1.5% and cardiac death or any death was 0.5%.Significant differences in baseline (p=0.001) and residual (p<0.01) between Syntax and ERACI score were found. No patients developed stent thrombosis. Conclusions: In this prospective multicenter observational registry performed in 12 centers of Argentina showed a high 30 days quality PCI performance in a real-world CAD population.

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Section: Discussionmentioning

confidence: 99%

In Hospital and 30 Days Results of the Prospective, Observational, Multicenter and Controlled “real world” WALTZ Registry

Lloberas¹,

Iravedra²,

Haeik³

et al. 2017

RACI

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“…El score de calcio, un subrogante de la carga de placa ateroesclerótica, es una herramienta segura (<1 mSv de dosis de radiación efectiva) que no requiere contraste, agujas, ni preparación alguna. Su valor pronóstico ha sido demostrado de forma consistente en una enorme cantidad de estudios multicéntricos de gran tamaño y seguimiento de hasta 15 años, independiente del sexo, etnia, factores de riesgo y de las pruebas funcionales [22][23][24] . Además, el score de calcio promueve cambios favorables en el estilo de vida, una mejor adherencia al tratamiento y una mejor selección de los pacientes con indicación de aspirina y estatinas [25][26][27][28] .…”

Section: Revista Argentina De Cardioangiología Intervencionista 2017;unclassified

“…Múltiples estudios han evaluado la superioridad de la OCT con respecto al IVUS en la determinación de mala aposición del stent en el seguimiento y posintervención inmediata 21,22 . Esta puede ser un gran aporte de la OCT al mundo de la revascularización por stent, debido a que efectos como la mala aposición del stent han sido ya relacionados a mayores tasas de reestenosis y stent trombosis en estudios realizados por IVUS [23][24][25] Con lo evaluado hasta el momento podemos ver entonces algunas limitaciones que oscurecen el potencial impacto clínico en la pesquisa invasiva de la placa vulnerable: la alta prevalencia de las placas de alto riesgo o cómo no todos los FACF se rompen y no muchas rupturas de placa desencadenan eventos clínicos. Otra desventaja está en que alrededor de un 40% de las trombosis agudas no tienen como sustrato la ruptura de placa sino otros mecanismos fisiopatológicos.…”

Section: En El Seguimiento Luego De Angioplastia Coronariaunclassified

“…Experiencias previas que evaluaron el comportamiento de diferentes modelos de riesgo internacionales en subpoblaciones con RVA aislado, mostraron pobres rendimientos en sus poderes predictivos. El EuroSCORE I, tanto en su versión logística como en su versión aditiva, sobreestimó el riesgo en pacientes con RVA aislado, mientras que el modelo de la Society of Thoracic Surgeons en general subestimó el riesgo en estas poblaciones [21][22][23][24][25][26] . Por otra parte, un metaanálisis de todas las publicaciones que buscaron validar el EuroSCORE I en pacientes con cirugía valvular mostró un mal rendimiento de este modelo tanto en la población global como en los pacientes con RVA 27 .…”

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2017

RACI

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Sumario analítico 109 known coronary artery disease and 24.4% with history of MI. The 67.2% of patients had an ACS, of which 31.8% had ST elevation MI. 46.8% of patients had multiple vessel disease and 1.34 vessels per patient were treated in the index procedure. Dual antiplatelet therapy was used in 100% of patients, 52.3% received clopidogrel as charging dose, 11.4% of prasugrel and 36.3% ticagrelor as preferred thyenopiridines. 30 days MACE was 1.5% and cardiac death or any death was 0.5%.Significant differences in baseline (p=0.001) and residual (p<0.01) between Syntax and ERACI score were found. No patients developed stent thrombosis. Conclusions: In this prospective multicenter observational registry performed in 12 centers of Argentina showed a high 30 days quality PCI performance in a real-world CAD population.

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“…Critical stenosis of the unprotected left main (ULM) have a detrimental impact on short and long term survival . Surgical revascularization has been for many years the first‐choice treatment, while in the last decade percutaneous coronary intervention (PCI) has affirmed itself as a viable option, showing similar long‐term results as compared to coronary artery bypass graft, especially in patients with low‐intermediate Syntax score values .…”

Section: Introductionmentioning

confidence: 99%

Self‐expandable sirolimus‐eluting stents compared to second‐generation drug‐eluting stents for the treatment of the left main: A propensity score analysis from the SPARTA and the FAILS‐2 registries

Montefusco

D’Ascenzo

Gili

et al. 2018

Cathet Cardio Intervent

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Objectives: To compare the effectiveness and safety of self-expandable, sirolimus-eluting Stentys stents (SES) and second-generation drug-eluting stents (DES-II) for the treatment of the unprotected left main (ULM).Background: SES may provide a valuable option to treat distal ULM, particularly when significant caliber gaps with side branches are observed.Methods: Patients from the multicenter SPARTA (clinicaltrials.gov: NCT02784405) and FAILS2 registries were included. Propensity-score with matching was performed to account for the lack of randomization. Primary end-point was the rate of major adverse cardiovascular events (MACE, a composite of all cause death, myocardial infarction, target lesion revascularization [TLR], unstable angina and definite stent thrombosis [ST]). Single components of MACE were the secondary end-points.Results: Overall, 151 patients treated with SES and 1270 with DES-II were included; no differences in MACE rate at 250 days were observed (9.8% vs. 11.5%, P = 0.54). After propensity score with matching, 129 patients treated with SES and 258 with DES-II, of which about a third of female gender, were compared. After a follow-up of 250 days, MACE rate did not differ between the two groups (9.9% vs. 8.5%, P = 0.66), as well as the rate of ULM TLR (1.6% vs. 3.1%, P = 0.36) and definite ST (0.8% vs. 1.2%, P = 0.78). These results were consistent also when controlling for the treatment with provisional vs. 2-stents strategies for the ULM bifurcation.Conclusion: SES use for ULM treatment was associated with a similar MACE rate compared to DES-II at an intermediate-term follow-up. SES might represent a potential option in this setting. K E Y W O R D Spercutaneous coronary intervention, second-generation drug-eluting stent, self-expandable stent, unprotected left main

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Can We Improve the Outcomes of Multivessel Disease Using Modified SYNTAX and Residual SYNTAX Scores?

Cited by 7 publications

References 35 publications

In Hospital and 30 Days Results of the Prospective, Observational, Multicenter and Controlled “real world” WALTZ Registry

In Hospital and 30 Days Results of the Prospective, Observational, Multicenter and Controlled “real world” WALTZ Registry

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Self‐expandable sirolimus‐eluting stents compared to second‐generation drug‐eluting stents for the treatment of the left main: A propensity score analysis from the SPARTA and the FAILS‐2 registries

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