Residual SYNTAX score following coronary artery bypass grafting†

Melina, Giovanni; Angeloni, Emiliano; Refice, Simone; Benegiamo, Cristian; Lechiancole, Andrea; Matteucci, M; Roscitano, Antonino; Bianchini, Roberto; Capuano, Fabio; Comito, Cosimo; Spitaleri, Pietro; Tonelli, Euclide; Speciale, Giulio; Pristipino, Christian; Monti, Francesco; Serdoz, Roberto; Paneni, Francesco; Sinatra, Riccardo

doi:10.1093/ejcts/ezw356

Cited by 15 publications

(17 citation statements)

References 24 publications

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“…It is our hypothesis that these low mortality rates are attributable, at least in part, to the low residual SYNTAX scores that were able to be achieved in each patient group, regardless of the technique of revascularization. There is good data to support the assertion that the completeness of revascularization (as quantified by the residual SYNTAX score) is a predictor of short‐to‐medium term MACE in patients with multivessel coronary artery disease undergoing PCI or CABG 26‐28 . Our group has previously reported that a low residual SYNTAX score after HCR was associated with 8‐year survival that was not significantly different than that seen after traditional CABG in patients with double‐vessel coronary disease 29 .…”

Section: Discussionmentioning

confidence: 85%

“…There is good data to support the assertion that the completeness of revascularization (as quantified by the residual SYNTAX score) is a predictor of short-to-medium term MACE in patients with multivessel coronary artery disease undergoing PCI or CABG. [26][27][28] Our group has previously reported that a low residual SYNTAX score after HCR was associated with 8-year survival that was not significantly different than that seen after traditional CABG in patients with double-vessel coronary disease. 29 Our current results suggest that HCR is also associated with favorable long-term results in patients with TVD, provided that the operators can achieve a low residual SYNTAX score.…”

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confidence: 98%

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Long‐term survival in triple‐vessel disease: Hybrid coronary revascularization compared to contemporary revascularization methods

et al. 2020

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Background Hybrid coronary revascularization (HCR) constitutes a left internal mammary artery graft to the left anterior descending (LAD) coronary artery, coupled with percutaneous coronary intervention (PCI) for non‐LAD lesions. This management strategy is not commonly offered to patients with complex multivessel disease. Our objective was to evaluate 8‐year survival in patients with triple‐vessel disease (TVD) treated by HCR, compared with that of concurrent matched patients managed by traditional coronary artery bypass grafting (CABG) or multivessel PCI. Methods A retrospective review was undertaken of 4805 patients with TVD who presented between January 2009 and December 2016. A cohort of 100 patients who underwent HCR were propensity‐matched with patients treated by CABG or multivessel PCI. The primary endpoint was all‐cause mortality at 8 years. Results Patients with TVD who underwent HCR had similar 8‐year mortality (5.0%) as did those with CABG (4.0%) or multivessel PCI (9.0%). A composite endpoint of death, repeat revascularization, and new myocardial infarction, was not significantly different between patient groups (HCR 21.0% vs CABG 15.0%, P = .36; HCR 21.0% vs PCI 25.0%, P = .60). Despite a higher baseline synergy between percutaneous coronary intervention with taxus and cardiac surgery(SYNTAX) score, HCR was able to achieve a lower residual SYNTAX score than multivessel PCI (P = .001). Conclusions In select patients with TVD, long‐term survival and FREEDOM from major adverse cardiovascular events after HCR are similar to that seen after traditional CABG or multivessel PCI. HCR should be considered for patients with multivessel disease, presuming a low residual SYNTAX score can be achieved.

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Section: Discussionmentioning

confidence: 85%

mentioning

confidence: 98%

Long‐term survival in triple‐vessel disease: Hybrid coronary revascularization compared to contemporary revascularization methods

et al. 2020

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“…SYNTAX score takes into account not only the luminal narrowing, but also other anatomic aspects, including bifurcation, trifurcation lesions, calcification, tortuosity, thrombus, and occlusions etc. Residual SYNTAX Score deriving from SYNTAX Score was used to quantify the residual burden of coronary artery disease after revascularization [12–14]. ICR was a surrogate marker of patients with more anatomically complex baseline disease.…”

Section: Discussionmentioning

confidence: 99%

“…For the patients who underwent CABG, the rSS was scored by comparing the bSS with the surgical procedure reports, the same, the final decision was made by consensus in cases of disagreement between the 2 cardiologists. Moreover, each vessel disease was still scored in terms of vessel characteristics (tortuosity, severe calcification) or any residual lesions distal to the graft allocation [14]. Patients were then classified into 2 groups based on the points of rSS: complete revascularization (CR): rSS = 0; incomplete revascularization (ICR): rSS > 0 [15].…”

Section: Methodsmentioning

confidence: 99%

“…The Synergy between percutaneous intervention with Taxus drug-eluting stents and cardiac surgery (SYNTAX) score has been developed to stratify the complexity and severity of coronary lesions [11]. Residual SYNTAX Score (rSS) was derived from SYNTAX score to quantify the burden of residual coronary artery disease after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG), and has been validated as an independent predictor for clinical adverse events [12–14]. However, studies examining the impact of rSS on patients with OSA and acute coronary syndrome (ACS) have not yet been elucidated.…”

Section: Backgroundsmentioning

confidence: 99%

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Prognostic impact of residual SYNTAX score in patients with obstructive sleep apnea and acute coronary syndrome: a prospective cohort study

et al. 2019

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Background There is a paucity of data from large prospective study evaluating the prognostic significance of the residual Synergy between percutaneous intervention with Taxus drug-eluting stents and cardiac surgery (SYNTAX) Score (rSS) in patients with obstructive sleep apnea (OSA) and Acute Coronary Syndrome (ACS). Methods ACS patients who undergoing percutaneous coronary angiography and completing a sleep study during hospitalization were prospectively enrolled. The baseline SYNTAX Score (bSS) and the rSS after revascularization were assessed. Complete revascularization (CR, rSS = 0) and incomplete revascularization (ICR, rSS > 0) were categorized. OSA (apnea hypopnea index, AHI ≥ 15) and non-OSA (AHI < 15) were grouped according to AHI. The primary endpoint of the study was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a composite of cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for UAP or heart failure. Results Overall, 752 patients were prospectively enrolled. At a median follow-up of 1 year, the incidence of MACCEs was significantly higher in the OSA than in the non-OSA group (hazard ratio [HR]:1.68; 95% confidence interval [CI]:1.04–2.72; P = .034). ICR was associated with a higher risk of MACCEs in the non-OSA group (HR:3.34;95% CI:1.0–11.12; P = .05). The OSA patients with ICR had a 5.1 higher risk of MACCEs compared with the non-OSA with CR group, P = .007. The OSA patients with CR had a similar 1-year MACCEs as all the non-OSA patients (HR:1.10; 95% CI:0.515–2.349; P = 0.806). Conclusions ACS patients with OSA and ICR have a high rate of MACCEs at 1 year. In contrast, the prognosis of ACS patients with OSA but CR is favorable and similar to patients without OSA. Adequate level of revascularization is recommended to optimize clinical outcomes in ACS patients with OSA. Trial registration Clinicaltrials.gov identifier NCT03362385.

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Myocardial revascularization failure among patients requiring cardiac catheterization and secondary revascularization in contemporary clinical practice: Results of the REVASEC multicenter registry

Salinas

García-Camarero

Jiménez-Kockar

et al. 2023

Cathet Cardio Intervent

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BackgroundMyocardial revascularization failure (MRF) and Secondary revascularization (SR) are contemporary interventional cardiology challenges.AimTo investigate the characteristics, management, and prognosis of patients with myocardial revascularization failure (MRF) and need for secondary revascularization (SR) in contemporary practice.MethodsThe REVASEC study is a prospective registry (NCT03349385), which recruited patients with prior revascularization referred for coronary angiography at 19 centers. The primary endpoint is a patient‐oriented composite (POCE) at 1 year, including death, myocardial infarction, or repeat revascularization.ResultsA total of 869 patients previously revascularized by percutaneous intervention (83%) or surgery (17%) were recruited. MRF was found in 83.7% (41.1% stent/graft failure, 32.1% progression of coronary disease, and 10.5% residual disease). SR was performed in 70.1%, preferably by percutaneous intervention (95%). The POCE rate at 1 year was 14% in the overall cohort, with 6.4% all‐cause death. In the multivariate analysis, lower POCE rates were found in the groups without MRF (9.4%) and with disease progression (11%) compared with graft/stent failure (17%) and residual disease (18%), hazard ratio 0.67 (95% confidence interval: 0.45–0.99), p = 0.043. At 1 year, the SR group had less chronic persistent angina (19% vs. 34%, p < 0.001), but a higher rate of repeat revascularization (9% vs. 2.9%, p < 0.001).ConclusionMRF was found in 84% of patients with prior revascularization referred for coronary angiography. Stent/graft failure and residual coronary disease were associated with a worse prognosis. SR provided better symptom control at the expense of a higher rate of new revascularization

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Residual SYNTAX score following coronary artery bypass grafting†

Cited by 15 publications

References 24 publications

Long‐term survival in triple‐vessel disease: Hybrid coronary revascularization compared to contemporary revascularization methods

Long‐term survival in triple‐vessel disease: Hybrid coronary revascularization compared to contemporary revascularization methods

Prognostic impact of residual SYNTAX score in patients with obstructive sleep apnea and acute coronary syndrome: a prospective cohort study

Myocardial revascularization failure among patients requiring cardiac catheterization and secondary revascularization in contemporary clinical practice: Results of the REVASEC multicenter registry

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