Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery and the SYNTAX score: A systematic review and meta-analysis

Bundhun, Pravesh Kumar; Yanamala, Chandra Mouli; Huang, Feng

doi:10.1038/srep43801

Cited by 18 publications

(22 citation statements)

References 28 publications

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“…However, newer scientific reports have shown its importance in Interventional cardiology as well, [18,19] but the fact that it also has limitations when compared with newer tools, we were compelled to further consider other tools. [20]…”

Section: Discussionmentioning

confidence: 99%

Use of the SYNTAX Score II to predict mortality in interventional cardiology

Yang¹,

Zhang

Xu³

2019

Medicine

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Background:As the SYNTAX Score has limitations, it should be replaced by another better angiographic tool. By comparing mortality that was observed following percutaneous coronary intervention (PCI) in patients who were allotted a low versus a high score, we aimed to systematically investigate mortality prediction using the SYNTAX Score II in Interventional Cardiology.Methods:Electronic databases were searched for relevant publications using the terms “SYNTAX Score II and percutaneous coronary intervention.” The main outcome was all-cause mortality. This analysis was carried out by the RevMan 5.3 software [risk ratios (RRs) and 95% confidence intervals (95% CIs) were calculated].Results:A total number of 9443 participants were enrolled for this analysis. As different studies reported different range of SYNTAX Score II, we further classified these scores range into 4 different groups: 17 < SS > 17, 20 < SS > 20, 22 < SS > 22, and 26 < SS > 26 appropriately. Results of this analysis showed that the risk of mortality in patients with a high SYNTAX Score II (SS > 17) was significantly higher (RR: 2.65, 95% CI: 1.05–6.73; P = .04) than patients with a low SYNTAX Score II (SS < 17). Even when participants with a low SYNTAX Score II (SS < 20) were compared with patients who were assigned to a higher SYNTAX Score II (SS > 20), a significantly higher risk of mortality was associated with a high SYNTAX Score II (RR: 3.73, 95% CI: 1.99 – 6.96; P = .0001).Conclusion:Following PCI, the risk of mortality was higher in those patients with a high SYNTAX Score II. The SYNTAX Score II might be considered as an important tool to predict mortality in Interventional Cardiology. Future research should further explore the benefits of this tool.

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Section: Discussionmentioning

confidence: 99%

Use of the SYNTAX Score II to predict mortality in interventional cardiology

Yang¹,

Zhang

Xu³

2019

Medicine

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“…At present, it is recommended to apply SYNTAX scores to the selection of revascularization strategies [40, 41]. Although the SYNTAX score might be considered useful in interventional cardiology, it has some limitations [42]. Compared with PCI, there was a higher risk of periprocedural stroke in patients undergoing CABG [43].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome comparison of percutaneous coronary intervention and bypass surgery in diabetic patients with coronary artery disease: a meta-analysis of randomized controlled trials and observational studies

Zhai

Cong

Hou

et al. 2019

Diabetol Metab Syndr

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BackgroundThe optimal revascularization technique in diabetic patients with complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD), remains controversial. The current study aimed to compare adverse clinical endpoints of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM).MethodsRelevant studies were found from MEDLINE, OVID, Science Direct, Embase and the Cochrane Central database from January 2010 to April 2019. Risk ratio (RR) with 95% confidence interval (CI) was used to express the pooled effect on discontinuous variables. Outcomes evaluated were all-cause mortality, major adverse cardiac/cerebrovascular events (MACCE), cardiac death, myocardial infarction, stroke, and repeat revascularization.ResultsSixteen studies were included (18,224 patients). PCI was associated with the increase risk for MACCE (RR 1.59, 95% CI 1.38–1.85), cardiac death (RR 1.76, 95% CI 1.11–2.80), MI (RR 1.98, 95% CI 1.53–2.57), repeat revascularization (RR 2.61, 95% CI 2.08–3.29). The risks for all-cause mortality (RR 1.23, 95% CI 1.00–1.52) and stroke (RR 0.71, 95% CI 0.48–1.03) were similar between two strategies. Stratified analysis based on studies design and duration of follow-up showed largely similar findings with the overall analyses, except for a significant increased risk of all-cause mortality (RR 1.32, 95% CI 1.04–1.67) in long-term group, and CABG was associated with a higher stroke rate compared to PCI, which are results that were found in RCTs (RR 0.47, 95% CI 0.28–0.79) and mid-term groups (RR 0.39, 95% CI 0.23–0.66).ConclusionsCABG was superior to PCI for diabetic patients with complex CAD (including left main CAD and/or MVD), but might be associated with a higher risk of stroke mid-term follow-up.Number of Protocol registration PROSPERO CRD 42019138505.

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“…[ 38 – 39 ] In addition, whether the SYNTAX score plays an integral part by contributing to the resulting adverse events should also be further studied. [ 40 – 42 ]…”

Section: Discussionmentioning

confidence: 99%

Choosing between ticagrelor and clopidogrel following percutaneous coronary intervention

Guan

Yang

2018

Medicine

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Background:Limitations have been observed with the use of clopidogrel following percutaneous coronary intervention (PCI) indicating the urgent need of a more potent anti-platelet agent. We aimed to compare the efficacy and safety of ticagrelor versus clopidogrel following PCI.Methods:Online databases were searched for relevant studies (published between the years 2007 and 2017) comparing ticagrelor versus clopidogrel following coronary stenting. Primary outcomes assessed efficacy whereas secondary outcomes assessed safety. Odds ratios (OR) with 95% confidence intervals (CIs) based on a random effect model were calculated and the analysis was carried out by the RevMan 5.3 software.Results:A total number of 25,632 patients with acute coronary syndrome (ACS) [12,992 patients with ST segment elevation myocardial infarction (STEMI) and 14,215 patients with non-ST segment elevation myocardial infarction (NSTEMI)] were included in this analysis, of whom 23,714 patients were revascularized by PCI. Results of this analysis did not show any significant difference in all-cause mortality, major adverse cardiac events (MACEs), myocardial infarction, stroke and stent thrombosis observed between ticagrelor and clopidogrel with (OR: 0.83, 95% CI: 0.67–1.03; P = .09), (OR: 0.64, 95% CI: 0.41–1.01; P = .06), (OR: 0.77, 95% CI: 0.57–1.03; P = .08), (OR: 0.85, 95% CI: 0.57–1.26; P = .42) and (OR: 0.70, 95% CI: 0.47–1.05; P =.09).However, ticagrelor was associated with a significantly higher minor and major bleeding with (OR: 1.57, 95% CI: 1.30–1.89; P = .00001) and (OR: 1.52, 95% CI: 1.01–2.29; P = 0.04) respectively. Dyspnea was also significantly higher in the ticagrelor group (OR: 2.64, 95% CI: 1.87–3.72; P = .00001).Conclusion:Ticagrelor and clopidogrel were comparable in terms of efficacy in these patients with ACS. However, the safety outcomes of ticagrelor should further be investigated.

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Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery and the SYNTAX score: A systematic review and meta-analysis

Cited by 18 publications

References 28 publications

Use of the SYNTAX Score II to predict mortality in interventional cardiology

Use of the SYNTAX Score II to predict mortality in interventional cardiology

Clinical outcome comparison of percutaneous coronary intervention and bypass surgery in diabetic patients with coronary artery disease: a meta-analysis of randomized controlled trials and observational studies

Choosing between ticagrelor and clopidogrel following percutaneous coronary intervention

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