External Validation of the SYNTAX Score II 2020

Hara, Hironori; Shiomi, Hiroki; Klaveren, David van; Kent, David M.; Garg, Scot; Onuma, Yoshinobu; Kimura, Takeshi; Serruys, Patrick W.

doi:10.1016/j.jacc.2021.07.027

Cited by 39 publications

(45 citation statements)

References 32 publications

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“…Hence, the current findings derived from the SYNTAX Score II 2020 may be overestimated and the predictive ability of the score when applied to real-world populations may be inferior to what was observed in the current study. However, the SYNTAX Score II 2020 has been externally validated in four randomised trials (the Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL), the Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease (PRECOMBAT), the Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease (BEST), the Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM)) and in a large, contemporary registry and showed a predictive performance as good as in the original SYNTAX cohort 18 28 29. Finally, the extended follow-up of the SYNTAXES trial up to 10 years was only for survival status, with data for other clinical endpoints with independent adjudication limited to 5 years.…”

Section: Discussionmentioning

confidence: 99%

Mortality after multivessel revascularisation involving the proximal left anterior descending artery

Ono

Hara

Gao

et al. 2022

Heart

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ObjectiveWe sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD).MethodsThis post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed.ResultsAmong 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, pinteraction=0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; pinteraction=0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality.ConclusionsAmong patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG.Trial registration numberSYNTAXES:NCT03417050; SYNTAX:NCT00114972.

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Section: Discussionmentioning

confidence: 99%

Mortality after multivessel revascularisation involving the proximal left anterior descending artery

Ono

Hara

Gao

et al. 2022

Heart

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“…ARDs in all-cause death at 5 years of <4.5% and $4.5% offer sensible cutoffs for "equipoise of PCI and CABG" and "CABG better," respectively. 8 We applied this criterion to the present study population to identify in a heterogeneous population with bifurcation lesion(s) who would benefit or be harmed following PCI or CABG.…”

Section: Methodsmentioning

confidence: 99%

“…14 The methodological foundation of this approach lies in the accuracy of outcome predictions for each modality of treatment, allowing personalized and individual predictions of the benefit of one treatment over another. 5,8 In the present study, the SS-2020 formally identified a cohort composed of 22.7% of patients in the randomized population who had bifurcation lesions and had a risk difference of <0 (ARD # 0%) in mortality between PCI and CABG (Central Illustration).…”

Section: Impact Of Bifurcation Lesions On All-causementioning

confidence: 99%

Predicted and Observed Mortality at 10 Years in Patients With Bifurcation Lesions in the SYNTAX Trial

Ninomiya

Serruys

Garg

et al. 2022

JACC: Cardiovascular Interventions

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“…On the other hand, the SYNTAX II score contains eight predictors: anatomical SYNTAX score, age, creatinine clearance, left ventricular ejection fraction (LVEF), unprotected left main coronary artery (ULMCA) disease, peripheral vascular disease, female sex, and chronic obstructive pulmonary disease (COPD) ( 18 , 19 ). It can significantly predict the difference in 4-year mortality between patients who underwent CABG and PCI.…”

Section: Introductionmentioning

confidence: 99%

Guidezilla™ guide extension catheter I for transradial coronary intervention

Lei

Liang

Fang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPercutaneous coronary intervention (PCI) is the preferred treatment method for coronary artery diseases (CAD). This study aimed to evaluate the effectiveness and complications of the Guidezilla™ guide extension catheter I (GGEC I) in transradial coronary intervention (TRI).MethodsThis case series study included patients with CAD who underwent TRI using the GGEC I between August 2016 and January 2019 at the First Affiliated Hospital of Xi’an Jiaotong University.ResultsA total of 221 patients aged 65.1 ± 9.26 years were included. Coronary angiography results indicated that most patients (77.8%) had triple-vessel lesions, including 47.5% with chronic total occlusion (CTO). A total of 237 target lesions were treated, most being type C lesions (95.8%). The most common indication for GGEC I use was heavy calcification (67%), followed by extreme tortuosity (12.2%), extreme tortuosity and heavy calcification (10.9%), distally located lesion (4.5%), picking up the retrograde wire (3.2%), anomalous vessel origin (1.8%), and releasing the burr incarceration (0.4%). The mean operation time was 58 min, and the overall success rate was 94.1%. Four patients received a drug-coated balloon. No significant differences were found in operation time and success rate among the low (<23), intermediate (23–32), and severe (>32) CAD groups based on SYNTAX score stratification (P > 0.05). Two subacute thrombosis cases each were reported perioperatively, during hospitalization, and at the 1-month follow-up.ConclusionThe GGEC I might have advantages for TRI and is unaffected by SYNTAX score stratification.

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External Validation of the SYNTAX Score II 2020

Cited by 39 publications

References 32 publications

Mortality after multivessel revascularisation involving the proximal left anterior descending artery

Mortality after multivessel revascularisation involving the proximal left anterior descending artery

Predicted and Observed Mortality at 10 Years in Patients With Bifurcation Lesions in the SYNTAX Trial

Guidezilla™ guide extension catheter I for transradial coronary intervention

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