Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS

Kobayashi, Yuhei; Lønborg, Jacob; Jong, Andy; Nishi, Takeshi; Bruyne, Bernard De; Høfsten, Dan Eik; Kelbæk, Henning; Layland, Jamie; Nam, Chang‐Wook; Pijls, Nico H.J.; Tonino, Pim A.L.; Warnøe, Julie; Oldroyd, Keith G.; Berry, Colin; Engstrøm, Thomas; Fearon, William F.; -Primulti, Fame Danami; Investigators, Famous-Nstemi Study

doi:10.1016/j.jacc.2018.06.069

Cited by 42 publications

(21 citation statements)

References 29 publications

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“… 14 , 15 , 29 , 30 Second, the presence of residual “anatomic” CAD after functionally complete revascularization has no impact on prognosis. 31 Third, the occurrence of procedural complications, especially those impacting the prognosis such as periprocedural MI and Contrast Induced-Acute Kidney Injury (CI-AKI), is directly proportional to both age and number of treated vessels. 32.…”

Section: Myocardial Infarction In Elderly Adultsmentioning

confidence: 99%

Physiology-guided revascularization versus optimal medical therapy of nonculprit lesions in elderly patients with myocardial infarction: Rationale and design of the FIRE trial

Biscaglia

Guiducci

Santarelli

et al. 2020

American Heart Journal

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Background Myocardial infarction (MI) in elderly patients is associated with unfavorable prognosis, and it is becoming an increasingly prevalent condition. The prognosis of elderly patients is equally impaired in ST-segment elevation (STE) or non-STE (NSTE), and it is markedly worsened by the common presence of multivessel disease (MVD). Given the limited evidence available for elderly patients, it has not yet been established whether, as for younger patients, a complete revascularization strategy in MI patients with MVD should be advocated. We present the design of a dedicated study that will address this research gap. Methods and design The FIRE trial is a prospective, randomized, international, multicenter, open-label study with blinded adjudicated evaluation of outcomes. Patients aged 75 years and older, with MI (either STE or NSTE), MVD at coronary artery angiography, and a clear culprit lesion will be randomized to culprit-only treatment or to physiology-guided complete revascularization. The primary end point will be the patient-oriented composite end point of all-cause death, any MI, any stroke, and any revascularization at 1 year. The key secondary end point will be the composite of cardiovascular death and MI. Quality of life and physical performance will be evaluated as well. All components of the primary and key secondary outcome will be tested also at 3 and 5 years. The sample size for the study is 1,400 patients. Implications The FIRE trial will provide evidence on whether a specific revascularization strategy should be applied to elderly patients presenting MI and MVD to improve their clinical outcomes.

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Section: Myocardial Infarction In Elderly Adultsmentioning

confidence: 99%

Physiology-guided revascularization versus optimal medical therapy of nonculprit lesions in elderly patients with myocardial infarction: Rationale and design of the FIRE trial

Biscaglia

Guiducci

Santarelli

et al. 2020

American Heart Journal

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“…Systematic characterization and quantification of residual atherosclerosis after PCI may be important to standardize and improve the prognostic utility of ICR. Higher RSS has been associated with worse outcome in patients undergoing angiography-mediated PCI [ 12 ]. In a post hoc analysis of the ACUITY trial including patients with moderate-high-risk non-ST elevation (NON-STEMI) acute coronary syndromes, RSS > 8.0 was an independent predictor of mortality and ischemic events at one year [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of the Residual SYNTAX Score on In-Hospital and Follow-Up Clinical Outcomes in ST Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Interventions

Altekin

Kılınç

Onac

et al. 2020

Cardiology Research and Practice

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Aims. We investigated the prognostic significance of residual SYNTAX score (RSS) in patients undergoing PCI due to STEMI and relationship between RSS and in-hospital and long-term ischemic cardiac events. Methods. Between June 2015 and December 2018, 538 patients who underwent primary PCI were evaluated for in-hospital events and 478 patients were evaluated for clinical events during follow-up. Primary and secondary endpoints for both in-hospital and follow-up periods were cardiac death and major adverse cardiac events (MACE). Results. 538 patients were included the study. RSS values of 131 patients were 0, and RSS values of 407 patients were >0. The median value of the RSS > 0 group was 7. According to this value, the RSS > 0 group was divided into 2 groups as R-ICR (RSS < 7, N = 188) and ICR (RSS ≥ 7, n = 219). In the RSS ≥ 7 group, during in-hospital and follow-up period, both mortality and MACE rates were higher than the other two groups. Area under the curve (AUC) for RSS for in-hospital death was found to be higher than SS ( p = 0.035 ) but similar to Grace Score (GS) ( p = 0.651 ). For MACE, RSS was higher than SS ( p = 0.025 ) and higher than the GS ( p = 0.041 ). For follow-up cardiac mortality, the AUC of the RSS was found to be higher than SS (0.870/0.763, p = 0.02 ) and GS (0.870/0.733, p = 0.001 ). For MACE, the AUC of RSS was higher than SS ( p = 0.03 ) and GS ( p = 0.004 ). Conclusions. High RSS values in STEMI patients are associated with increased risk of ischemic cardiac events. RSS may help determine revascularization and level of additional PCI to improve prognosis by reducing the risk of ischemic cardiac events after P-PCI.

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“…A previous study reported that ACC/AHA lesion classifications and the SYNTAX score were anatomically based tools for quantitatively characterizing the coronary vasculature with respect to the number, location, complexity, and functional impact of angiographically obstructive lesions, and they were associated with adverse cardiovascular events and predicted mortality and morbidity in patients with CAD. [23][24][25][26] Another study reported that the SYNTAX score was associated with the severity of atherosclerosis in the aorta. 27 In this study, according to the ACC/AHA lesion classifications and SYNTAX score, the disease severity of the coronary arteries was closely corrected with the presence of PCR, which is a type of AAP.…”

Section: Association Between Puff-chandelier Rupture and Clinical Fmentioning

confidence: 99%

Clinical significance of the presence of puff‐chandelier ruptures detected by nonobstructive aortic angioscopy

Yoshizumi

Yonetsu

Hoshino

et al. 2019

Cathet Cardio Intervent

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Objective: This study aimed to investigate the prevalence and prognostic significance of atherosclerotic aortic plaques (AAPs) or specific AAP types detected by nonobstructive angioscopy (NOA) in patients who underwent percutaneous coronary intervention (PCI). Background: Although recent studies have reported the presence of various patterns of AAPs, identified by NOA, the clinical significance of the presence of AAPs remains elusive. Methods: In this retrospective, multicenter cohort study, a total of 167 patients who underwent PCI and intra-aortic scans with NOA were studied. The association between AAPs and the incidence of major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, stroke, and clinically driven unplanned revascularizations, was assessed. Results: AAPs were detected in 126 patients (75%) who underwent NOA. MACEs occurred in 28 (17%) patients during the follow-up (median 2.9 years [range 2.1-3.8]). Among all types of AAPs, only puff-chandelier rupture (PCR) showed a significant difference in frequency between patients with and those without MACEs: 21 (75%) and 49 (35%), respectively (p < .001). Multivariable Cox proportional hazard analysis revealed that PCR (hazard ratio [HR] 3.73, 95% confidence interval [CI] 1.57-8.87, p = .004) and chronic kidney disease (HR 2.97, 95% CI 1.37-6.44, p = .010) were independent predictors of MACEs. Kaplan-Meier analysis revealed that PCR was significantly associated with more frequent MACEs. Conclusion: The detection of PCR in the aorta using NOA was significantly associated with an increased risk of subsequent adverse events after PCI.

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Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS

Cited by 42 publications

References 29 publications

Physiology-guided revascularization versus optimal medical therapy of nonculprit lesions in elderly patients with myocardial infarction: Rationale and design of the FIRE trial

Physiology-guided revascularization versus optimal medical therapy of nonculprit lesions in elderly patients with myocardial infarction: Rationale and design of the FIRE trial

Prognostic Value of the Residual SYNTAX Score on In-Hospital and Follow-Up Clinical Outcomes in ST Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Interventions

Clinical significance of the presence of puff‐chandelier ruptures detected by nonobstructive aortic angioscopy

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