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Leone PP, Colombo A. Egg or Chicken First?: Is it Really Useful to Achieve Complete Revascularization? JACC Cardiovasc Interv 2023; 16:620. [PMID: 36922051 DOI: 10.1016/j.jcin.2023.01.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 03/18/2023]
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Koo BK, Hu X, Kang J, Zhang J, Jiang J, Hahn JY, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Ahn SG, Yoon MH, Kim U, Lee JM, Hwang D, Ki YJ, Shin ES, Kim HS, Tahk SJ, Wang J. Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI. N Engl J Med 2022; 387:779-789. [PMID: 36053504 DOI: 10.1056/nejmoa2201546] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In patients with coronary artery disease who are being evaluated for percutaneous coronary intervention (PCI), procedures can be guided by fractional flow reserve (FFR) or intravascular ultrasonography (IVUS) for decision making regarding revascularization and stent implantation. However, the differences in clinical outcomes when only one method is used for both purposes are unclear. METHODS We randomly assigned 1682 patients who were being evaluated for PCI for the treatment of intermediate stenosis (40 to 70% occlusion by visual estimation on coronary angiography) in a 1:1 ratio to undergo either an FFR-guided or IVUS-guided procedure. FFR or IVUS was to be used to determine whether to perform PCI and to assess PCI success. In the FFR group, PCI was to be performed if the FFR was 0.80 or less. In the IVUS group, the criteria for PCI were a minimal lumen area measuring either 3 mm2 or less or measuring 3 to 4 mm2 with a plaque burden of more than 70%. The primary outcome was a composite of death, myocardial infarction, or revascularization at 24 months after randomization. We tested the noninferiority of the FFR group as compared with the IVUS group (noninferiority margin, 2.5 percentage points). RESULTS The frequency of PCI was 44.4% among patients in the FFR group and 65.3% among those in the IVUS group. At 24 months, a primary-outcome event had occurred in 8.1% of the patients in the FFR group and in 8.5% of those in the IVUS group (absolute difference, -0.4 percentage points; upper boundary of the one-sided 97.5% confidence interval, 2.2 percentage points; P = 0.01 for noninferiority). Patient-reported outcomes as reported on the Seattle Angina Questionnaire were similar in the two groups. CONCLUSIONS In patients with intermediate stenosis who were being evaluated for PCI, FFR guidance was noninferior to IVUS guidance with respect to the composite primary outcome of death, myocardial infarction, or revascularization at 24 months. (Funded by Boston Scientific; FLAVOUR ClinicalTrials.gov number, NCT02673424.).
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Affiliation(s)
- Bon-Kwon Koo
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Xinyang Hu
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jeehoon Kang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jinlong Zhang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jun Jiang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Joo-Yong Hahn
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Chang-Wook Nam
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Joon-Hyung Doh
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Bong-Ki Lee
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Weon Kim
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jinyu Huang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Fan Jiang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Hao Zhou
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Peng Chen
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Lijiang Tang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Wenbing Jiang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Xiaomin Chen
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Wenming He
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Sung-Gyun Ahn
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Myeong-Ho Yoon
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Ung Kim
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Joo-Myung Lee
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Doyeon Hwang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - You-Jeong Ki
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Eun-Seok Shin
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Hyo-Soo Kim
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Seung-Jea Tahk
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jian'an Wang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
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Akbari T, Al-Lamee R. Percutaneous coronary intervention in multi-vessel disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 44:80-91. [DOI: 10.1016/j.carrev.2022.06.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 01/09/2023]
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Zhao X, Wang Y, Chen R, Li J, Zhou J, Liu C, Zhou P, Sheng Z, Chen Y, Song L, Zhao H, Yan H. Prognostic value of characteristics of plaque combined with residual syntax score among patients with STEMI undergoing primary PCI: an intravascular optical coherence tomography study. Thromb J 2021; 19:85. [PMID: 34772417 PMCID: PMC8588603 DOI: 10.1186/s12959-021-00329-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/10/2021] [Indexed: 11/10/2022] Open
Abstract
Aim The present study aimed to explore these characteristics, particularly thin-cap fibroatheroma (TCFA), in relation to residual syntax score (rSS) in patients who presented with acute MI. Methods and outcomes A total of 434 consecutive patients with MI aged ≥18 years who had STEMI underwent primary PCI. Notably, compared with other subgroups, the presence of TCFA in culprit lesions and a higher level of rSS, were significantly associated with MACE. When rSS was divided into three groups, high rSS levels were associated with a higher incidence of MACE, in the subgroups of without TCFA (P = 0.005), plaque erosion (P = 0.045), macrophage infiltration (P = 0.026), and calcification (P = 0.002). AUC of ROC curve was 0.794 and 0.816, whereas the AUC of the survival ROC was 0.798 and 0.846. Conclusion The results of this study could be used in clinical practice to support risk stratification. Trial registration This study was registered at ClinicalTrials.gov as NCT03593928. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-021-00329-z.
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Affiliation(s)
- Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China.
| | - Hongbing Yan
- , Fuwai Hospital, Chinese Academy of Medical Sciences, 12 Langshan Rd, Shenzhen, 518000, China.
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Wang Y, Zhao X, Zhou P, Liu C, Sheng Z, Li J, Zhou J, Chen R, Chen Y, Song L, Zhao H, Yan H. Culprit-Plaque Morphology and Residual SYNTAX Score Predict Cardiovascular Risk in Acute Myocardial Infarction: An Optical Coherence Tomography Study. J Atheroscler Thromb 2021; 29:1328-1341. [PMID: 34544957 PMCID: PMC9444676 DOI: 10.5551/jat.63103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims: Culprit-plaque morphology [plaque rupture (PR) and plaque erosion (PE)] and high-risk plaques (HRP) identified by optical coherence tomography (OCT) and residual SYNTAX score (rSS) have been reported to influence clinical outcomes. Thus, in this study, we aimed to investigate the prognostic implication of culprit-plaque morphology and rSS for major adverse cardiovascular events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI).
Methods: Based on plaque morphology and rSS, 274 STEMI patients were divided into 4 groups: PE/low-rSS (n=61), PE/high-rSS (n=58), PR/low-rSS (n=55), and PR/high-rSS (n=100). According to HRP and rSS, patients were stratified to non-HRP/low-rSS (n=97), non-HRP/high-rSS (n=109), HRP/low-rSS (n=19), and HRP/high-rSS (n=49). MACE was defined as the composite of all-cause death, recurrence of myocardial infarction, stroke, and unplanned revascularization of any coronary artery.
Results: During the follow-up of 2.2 years, 47 (17.2%) MACE were observed. Patients with PR/high-rSS and HRP/high-rSS presented lower survival probability on revascularization and MACE. In fully adjusted analyses, PR/high-rSS group presented higher MACE risk than PE/low-rSS (HR: 4.80, 95% CI: 1.43–16.11,P=0.025). Patients with non-HRP/high-rSS (HR: 2.90, 95% CI: 1.01–8.38,P=0.049) and HRP/high-rSS (HR: 8.67, 95% CI: 2.67–28.21,P＜0.001) presented higher risk of cardiac events than non-HRP/low-rSS. Adding rSS and HRP to the risk prediction model increased the C-statistic to 0.797 (95% CI: 0.737–0.857), with ΔC-statistic of 0.066 (P=0.002) and the NRI (46.0%, 95% CI: 20.5–56.8%,P＜0.001) and IDI (8.7%, 95% CI: 3.6–18.2%,P＜0.001).
Conclusion: High-risk plaques in combination with rSS enhanced the predictive ability for MACE, indicating culprit-plaque features and residual atherosclerosis burden should be taken into account in risk stratification of STEMI patients.
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Affiliation(s)
- Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences.,Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences
| | - Hongbing Yan
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences
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Barthélémy O, Rouanet S, Brugier D, Vignolles N, Bertin B, Zeitouni M, Guedeney P, Hauguel-Moreau M, Hage G, Overtchouk P, Akin I, Desch S, Vicaut E, Zeymer U, Thiele H, Montalescot G. Predictive Value of the Residual SYNTAX Score in Patients With Cardiogenic Shock. J Am Coll Cardiol 2021; 77:144-155. [PMID: 33446307 DOI: 10.1016/j.jacc.2020.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/22/2020] [Accepted: 11/03/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND In hemodynamically stable patients, complete revascularization (CR) following percutaneous coronary intervention (PCI) is associated with a better prognosis in chronic and acute coronary syndromes. OBJECTIVES This study sought to assess the extent, severity, and prognostic value of remaining coronary stenoses following PCI, by using the residual SYNTAX score (rSS), in patients with cardiogenic shock (CS) related to myocardial infarction (MI). METHODS The CULPRIT-SHOCK (Culprit Lesion Only Percutaneous Coronary Intervention [PCI] Versus Multivessel PCI in Cardiogenic Shock) trial compared a multivessel PCI (MV-PCI) strategy with a culprit lesion-only PCI (CLO-PCI) strategy in patients with multivessel coronary artery disease who presented with MI-related CS. The rSS was assessed by a central core laboratory. The study group was divided in 4 subgroups according to tertiles of rSS of the participants, thereby isolating patients with an rSS of 0 (CR). The predictive value of rSS for the 30-day primary endpoint (mortality or severe renal failure) and for 30-day and 1-year mortality was assessed using multivariate logistic regression. RESULTS Among the 587 patients with an rSS available, the median rSS was 9.0 (interquartile range: 3.0 to 17.0); 102 (17.4%), 100 (17.0%), 196 (33.4%), and 189 (32.2%) patients had rSS = 0, 0 < rSS ≤5, 5 < rSS ≤14, and rSS >14, respectively. CR was achieved in 75 (25.2%; 95% confidence interval [CI]: 20.3% to 30.5%) and 27 (9.3%; 95% CI: 6.2% to 13.3%) of patients treated using the MV-PCI and CLO-PCI strategies, respectively. After multiple adjustments, rSS was independently associated with 30-day mortality (adjusted odds ratio per 10 units: 1.49; 95% CI: 1.11 to 2.01) and 1-year mortality (adjusted odds ratio per 10 units: 1.52; 95% CI: 1.11 to 2.07). CONCLUSIONS Among patients with multivessel disease and MI-related CS, CR is achieved only in one-fourth of the patients treated using an MV-PCI strategy. and the residual SYNTAX score is independently associated with early and late mortality.
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Affiliation(s)
- Olivier Barthélémy
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | | | - Delphine Brugier
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Nicolas Vignolles
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Benjamin Bertin
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Michel Zeitouni
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Paul Guedeney
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Marie Hauguel-Moreau
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Georges Hage
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Pavel Overtchouk
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Ibrahim Akin
- First Department of Medicine, Mannheim University Medical Center, Mannheim, Germany
| | - Steffen Desch
- Leipzig Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Eric Vicaut
- ACTION Study Group, Clinical Research Unit, Lariboisière Hospital, Paris, France
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Holger Thiele
- Leipzig Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Gilles Montalescot
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France.
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7
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Wang Y, Zhao X, Zhou P, Liu C, Sheng Z, Li J, Zhou J, Chen R, Chen Y, Song L, Zhao H, Yan H. Residual SYNTAX Score in Relation to Coronary Culprit Plaque Characteristics and Cardiovascular Risk in ST Segment Elevation Myocardial Infarction: an Intravascular Optical Coherence Tomography Study. J Cardiovasc Transl Res 2021; 15:75-83. [PMID: 34244969 DOI: 10.1007/s12265-021-10152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022]
Abstract
This study aimed to investigate the association of high-risk culprit plaque features by optical coherence tomography (OCT) with residual SYNTAX score (rSS) and the predictive value of rSS for major adverse cardiac events (MACE) in patients with ST segment elevation myocardial infarction (STEMI). We included 274 patients and divided them into 3 groups - rSS=0 (n=72), 0<rSS≤8 (n=134), and rSS>8 (n=68). There were significant differences in plaque characteristics among three groups (plaque rupture: 44.4% versus 59.0% versus 64.7%, lowest to highest rSS, p=0.040; OCT-defined high-risk plaques: 16.7% versus 23.9% versus 35.3%, lowest to highest rSS, p=0.036; calcification: 38.9% versus 52.5% versus 61.8%, lowest to highest rSS, p=0.024). During a mean follow-up of 2.2 years, MACE occurred in 47 (17.2%) patients; rSS >8 group had higher MACE risk compared to rSS=0 (HR: 2.68, 95%CI: 1.11-6.5, P=0.029). In conclusion, culprit plaque morphology was significantly correlated with rSS, and elevated rSS was associated with higher cardiovascular risk in STEMI patients. ClinicalTrials.gov : NCT03593928.
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Affiliation(s)
- Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China.,Fuwai Hospital, Chinese Academy of Medical Sciences, No. 12, Langshan Road, Xili Street, Nanshan District, Shenzhen, 518000, China
| | - Hongbing Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, No. 12, Langshan Road, Xili Street, Nanshan District, Shenzhen, 518000, China.
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8
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Yan L, Li P, Wang Y, Han D, Li S, Jiang M, Cao X, Cao F. The Incremental Prognostic Value of the Clinical Residual SYNTAX Score for Patients With Chronic Renal Insufficiency Undergoing Percutaneous Coronary Intervention. Front Cardiovasc Med 2021; 8:647720. [PMID: 33937361 PMCID: PMC8082103 DOI: 10.3389/fcvm.2021.647720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The residual SYNTAX score (RSS) is considered a powerful prognostic indicator for determining a reasonable revascularization strategy in patients undergoing percutaneous coronary intervention (PCI), but the absence of clinical parameters is one of the limitations of RSS, especially in the chronic renal insufficiency (CRI) comorbidity setting. The present work aimed to investigate the incremental prognostic value of clinical residual SYNTAX score (CRSS) compared with RSS in CRI cases after PCI. Methods: Totally 2,468 consecutive CRI cases who underwent PCI from January 2014 to September 2017 were included in this retrospective analysis. CRSS was obtained by multiplying RSS by the modified ACEF score. Individuals with CRSS >0 were considered to have incomplete revascularization and stratified by CRSS tertiles, the remaining cases constituted the complete revascularization (CR) group. The outcomes between these groups were compared. Results: At a median follow-up of 3 years, compared with CR group, individuals with CRSS >12 showed elevated rates of all clinical outcomes, and those with CRSS ≤ 12 showed similar all-cause and cardiac mortality rates. In multivariable analysis, CRSS was a powerful independent predictive factor of all clinical outcomes. The net reclassification improvement levels of CRSS over RSS for all-cause and cardiac mortality rates were 10.3% (p = 0.007) and 16.4% (p < 0.001), respectively. Compared with RSS, CRSS markedly ameliorated all-cause and cardiac mortality risk stratification. Conclusions: Compared with RSS, CRSS has incremental predictability for long-term all-cause and cardiac mortality in CRI cases following PCI.
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Affiliation(s)
- Liqiu Yan
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.,Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, China
| | - Peiyao Li
- Department of Computer Science, Tsinghua University, Beijing, China.,Artificial Intelligence Lab, Global Health Drug Discovery Institute, Beijing, China
| | - Yabin Wang
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Dong Han
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Sulei Li
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Min Jiang
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xufen Cao
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, China
| | - Feng Cao
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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9
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Leonardi S, Capodanno D, Sousa-Uva M, Vrints C, Rex S, Guarracino F, Bueno H, Lettino M, Price S, Valgimigli M, Jeppsson A. Composition, structure, and function of heart teams: a joint position paper of the ACVC, EAPCI, EACTS, and EACTA focused on the management of patients with complex coronary artery disease requiring myocardial revascularization. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:83-93. [PMID: 33721018 DOI: 10.1093/ehjacc/zuaa013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/11/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022]
Abstract
Contemporary cardiovascular medicine is complex, dynamic, and interactive. Therefore, multidisciplinary dialogue between different specialists is required to deliver optimal and patient-centred care. This has led to the concept of explicit collaborations of different specialists caring for patients with complex cardiovascular diseases-that is 'heart teams'. These teams are particularly valuable to minimize referral bias and improve guideline adherence as so to be responsive to patient preferences, needs, and values but may be challenging to coordinate, especially in the acute setting. This position paper-jointly developed by four cardiovascular associations-is intended to provide conceptual and practical considerations for the composition, structure, and function of multidisciplinary teams. It focuses on patients with complex coronary artery diseases in both elective and urgent setting and provide guidance on how to implement the heart team both in chronic and in acute coronary syndromes patients, including cases with mechanical complications and haemodynamic instability; it also discuss strategies for clear and transparent patient communication and provision of a patient-centric approach. Finally, gaps in evidence and research perspectives in this context are discussed.
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Affiliation(s)
- Sergio Leonardi
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia, Italy.,Coronary Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Davide Capodanno
- Unità Operativa di Cardiologia, Dipartimento Cardio-Toraco-Vascolare e Trapianti, C.A.S.T., P.O. "G. Rodolico", A.O.U. "Policlinico-Vittorio Emanuele and Università di Catania, Italy
| | - Miguel Sousa-Uva
- Cardiac Surgery Department, Hospital Santa Cruz, Avenue Prof Reynaldo dos Santos, 2790-134 Carnaxide, Portugal.,Cardiovascular Research Centre, Department of Surgery and Physiology, Faculty of Medicine-University of Porto, Alameda Prof Hernani Monteiro, Porto, Portugal
| | | | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Belgium.,Department of Cardiovascular Sciences KU Leuven, Belgium
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Susanna Price
- Division of Adult Intensive Care and Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, University Hospital of Bern, Bern 3010, Switzerland
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clincal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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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. Cardiol Res Pract 2020; 2020:9245431. [PMID: 33178454 PMCID: PMC7644317 DOI: 10.1155/2020/9245431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022] Open
Abstract
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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11
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Kashiwagi D, Ebisawa S, Yui H, Maruyama S, Nagae A, Sakai T, Kato T, Saigusa T, Okada A, Motoki H, Kuwahara K. Prognostic usefulness of residual SYNTAX score combined with clinical factors for patients with acute coronary syndrome who underwent percutaneous coronary intervention from the SHINANO Registry. Heart Vessels 2020; 36:170-179. [PMID: 32761363 DOI: 10.1007/s00380-020-01680-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022]
Abstract
The optimal strategy for percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) with multi-vessel disease (MVD) is still controversial. Residual anatomical features alone are not sufficient to appropriately stratify patient risk. Our aim was to assess the effectiveness of the residual Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (rSS) combined with clinical factors to predict long-term clinical outcomes in ACS patients. A total of 120 patients with ACS and MVD undergoing PCI were recruited from the SHINANO 5-year registry: a prospective, multi-center, cohort study. The rSS combined with clinical factors (Combined Score) were calculated based on the residual coronary angiogram and each clinical feature after primary PCI. The Combined Score was calculated by replacing SS with rSS using the SYNTAX score II (SSII) calculator. We grouped the Combined Score in two groups according to the cut-off value calculated by the ROC curve (the C-statistic was 0.82 [95% CI 0.74-0.91]) for all-cause mortality. The primary endpoint was all-cause mortality during the 5-year follow-up. The Combined Score was associated with long-term mortality in Cox-regression analysis (HR 1.08, 95% CI 1.05-1.11, P < 0.001). The mortality rate was significantly higher in the high-score group compared with the low-score group (5.7% vs 38.0%; P < 0.001). In ACS with MVD, the Combined Score might be considered an important tool to predict long-term mortality following PCI.
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Affiliation(s)
- Daisuke Kashiwagi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, 390-8621, Japan.
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, 390-8621, Japan
| | - Hisanori Yui
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, 390-8621, Japan
| | - Shusaku Maruyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, 390-8621, Japan
| | - Ayumu Nagae
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, 390-8621, Japan
| | - Takahiro Sakai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, 390-8621, Japan
| | - Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, 390-8621, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, 390-8621, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, 390-8621, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, 390-8621, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, 390-8621, Japan
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12
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Kang J, Zheng C, Park KW, Park J, Rhee T, Lee HS, Han JK, Yang HM, Kang HJ, Koo BK, Kim HS. Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction. J Clin Med 2020; 9:jcm9010232. [PMID: 31952345 PMCID: PMC7019798 DOI: 10.3390/jcm9010232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 01/26/2023] Open
Abstract
The benefit of complete revascularization (CR) in ST-segment elevation myocardial infarction (STEMI) patients with left ventricular (LV) dysfunction is uncertain. A total of 1314 STEMI patients with multivessel coronary artery disease were analyzed. CR was defined angiographically and by a residual Synergy between PCI with Taxus and Cardiac Surgery trial (SYNTAX) score (SS) <8. Patients with a left ventricular ejection fraction (LVEF) <40% were classified as the reduced LVEF group. The major study endpoints were patient-oriented composite outcome (POCO) and cardiac death during three-year follow-up. Overall, patients that received angiographic CR (579 patients, 44.1%) had significantly lower three-year clinical events compared with incomplete revascularization (iCR). CR reduced three-year POCO and cardiac death rates in the preserved LVEF group (POCO: 13.2% vs. 21.9%, p < 0.001, cardiac death: 1.8% vs. 6.5%, p < 0.001, respectively) but not in the reduced LVEF group (POCO: 26.0% vs. 33.1%, p = 0.275, cardiac death: 15.1% vs. 19.0%, p = 0.498, respectively). Multivariate analysis showed that CR significantly reduced three-year POCO (hazard ration (HR) 0.59, 95% confidence interval (CI) 0.43–0.82) and cardiac death (HR 0.34, 95% CI 0.14–0.80), only in the preserved LVEF group. Additionally, the results were corroborated using the SS-based CR definition. In STEMI patients with multivessel disease, CR did not improve clinical outcomes in those with reduced LVEF.
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13
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Yan L, Li P, Wang Y, Han D, Li S, Zhang J, Jiang M, Fan L, Han Y, Cao F. Impact of the residual SYNTAX score on clinical outcomes after percutaneous coronary intervention for patients with chronic renal insufficiency. Catheter Cardiovasc Interv 2019; 95 Suppl 1:606-615. [PMID: 31868307 PMCID: PMC7078880 DOI: 10.1002/ccd.28652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/08/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study demonstrated the prognostic value of the residual SYNTAX score (rSS) for patients with chronic renal insufficiency (CRI). BACKGROUND The rSS has been proposed as a useful tool for quantifying and stratifying the degree and complexity of residual stenosis and predicting long-term clinical outcomes following percutaneous coronary intervention (PCI). However, it has never been validated for patients with CRI. METHODS A total of 2,468 consecutive patients with an estimated glomerular filtration rate <90 ml/min/1.73 m2 who underwent PCI were retrospectively enrolled. Patients with rSS >0 were defined as having incomplete revascularization and were stratified into the reasonable incomplete revascularization (RICR; 0 < rSS ≤ 8) group or the incomplete revascularization (ICR; rSS >8) group. Their outcomes were compared to those of the complete revascularization (CR) group. RESULTS During follow-up (median, 3 years; range, 1.5-5 years), the ICR group had the highest incidence of all-cause death, cardiac death, myocardial infarction (MI), unplanned revascularization, stroke, and major adverse cardiovascular and cerebrovascular events (MACCE). Despite having higher rates of unplanned revascularization and MACCE, RICR group had comparable all-cause mortality, cardiac mortality, MI, and stroke with CR group. A multivariable Cox analysis indicated that rSS was an independent predictor of cardiac death, MI, unplanned revascularization, stroke, and MACCE. Furthermore, compared with baseline SYNTAX score, rSS had stronger prognostic accuracy when predicting the risk of unplanned revascularization, stroke, and MACCE at the 3-year follow-up. CONCLUSIONS The rSS is a powerful indicator of clinical outcomes and may help determine reasonable levels of revascularization for patients with CRI following PCI.
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Affiliation(s)
- Liqiu Yan
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China.,Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, China
| | - Peiyao Li
- Department of Computer Science, Tsinghua University, Beijing, China.,Department of Biomedical Engineering, Chinese PLA General Hospital, Beijing, China
| | - Yabin Wang
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Dong Han
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Sulei Li
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Jibin Zhang
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Min Jiang
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Li Fan
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Feng Cao
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
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14
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Kang J, Han JK, Kang DY, Zheng C, Yang HM, Park KW, Kang HJ, Koo BK, Kim HS. SYNTAX Score and SYNTAX Score II Can Predict the Clinical Outcomes of Patients with Left Main and/or 3-Vessel Disease Undergoing Percutaneous Coronary Intervention in the Contemporary Cobalt-Chromium Everolimus-Eluting Stent Era. Korean Circ J 2019; 50:22-34. [PMID: 31642213 PMCID: PMC6923234 DOI: 10.4070/kcj.2019.0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/14/2019] [Accepted: 09/04/2019] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives The impact of SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery score (SS) and SS II in patients who receive percutaneous coronary intervention with second-generation everolimus-eluting stents (EES) has not been fully validated. Methods The SS, SS II were calculated in 1,248 patients with left main and/or 3-vessel disease treated with EES. Patient-oriented composite endpoint (POCE; all-cause death, any myocardial infarction (MI), any revascularization) and target lesion failure (TLF: cardiac death, target-vessel MI, target lesion revascularization) were analyzed. Results The mean SS was 21.1±9.6. Three-year POCE increased according to the SS group (15.2% vs. 19.9% vs. 27.4% for low (≤22), intermediate (≥23, ≤32), high (≥33) SS groups, p<0.001). By multivariate Cox proportional hazard analysis, SS group was an independent predictor of 3-year POCE (hazard ratio, 1.324; 95% confidence interval, 1.095–1.601; p=0.004). The receiver operating characteristic curves revealed that the SS II was superior to the SS for 3-year POCE prediction (area under the curve [AUC]: 0.611 vs. 0.669 for SS vs. SS II, p=0.019), but not for 3-year TLF (AUC: 0.631 vs. 0.660 for SS vs. SS II, p=0.996). In subgroup analysis, SS II was superior to SS in patients with cardiovascular clinical risk factors, and in those presenting as stable angina. Conclusions The usefulness of SS and SS II was still valid in patients with left main and/or 3-vessel disease. SS II was superior to SS for the prediction of patient-oriented outcomes, but not for lesion-oriented outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT00698607 ClinicalTrials.gov Identifier: NCT01605721
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Affiliation(s)
- Jeehoon Kang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, Korea
| | - Jung Kyu Han
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, Korea.
| | - Do Yoon Kang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, Korea
| | - Chengbin Zheng
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, Korea
| | - Han Mo Yang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, Korea
| | - Kyung Woo Park
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, Korea
| | - Hyun Jae Kang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, Korea
| | - Bon Kwon Koo
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, Korea
| | - Hyo Soo Kim
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, Korea
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15
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Su CS, Shen CH, Chang KH, Lai CH, Liu TJ, Chen KJ, Lin TH, Chen YW, Lee WL. Clinical outcomes of patients with multivessel coronary artery disease treated with robot-assisted coronary artery bypass graft surgery versus one-stage percutaneous coronary intervention using drug-eluting stents. Medicine (Baltimore) 2019; 98:e17202. [PMID: 31567970 PMCID: PMC6756629 DOI: 10.1097/md.0000000000017202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A number of studies have reported on treatment outcomes of coronary stenting (PCI) for multivessel coronary artery diseases (MVD), and compared them with the conventional coronary artery bypass grafting (CABG). However, the clinical outcomes of robot-assisted CABG (R-CABG) in comparison with PCI in MVD patients have not been investigated.We recruited retrospectively MVD patients receiving R-CABG and PCI with drug-eluting stents for all vessels in one stage between January 2005 and December 2013 at our institution with at least 3 years of outcomes were retrospectively recruited and analyzed.A total of 638 MVD patients were studied. Among them, 281 received R-CABG, and 357 received PCI. Similar complete revascularizations were achieved in both groups (R-CABG: 40.2%, PCI: 41.5%, P = .751). The residual stenosis was 4.1 ± 4.4 in the R-CABG group, and comparably 3.5 ± 3.7 in the PCI group (P = .077). Patients in the R-CABG group were younger, with more severe coronary artery disease (CAD) and had more background risk factors. The in-hospital and long-term mortalities as well as the incidence of TLR, myocardial infarction (MI), stroke were all similar between groups. But the incidence of TVR and any revascularization were lower in the R-CABG group. The long-term mortality was predicted by age, left ventricular ejection fraction, and chronic kidney disease, but not by the revascularization modality, completeness of revascularization, nor residual SYNTAX scores. The last 3 factors were not predictors of long-term TLR, TVR, MI, and stroke.The in-hospital and long-term survival rates of MVD were similar for both the R-CABG and PCI groups. But the R-CABG group had rates of TVR and any revascularization lower than PCI. Revascularization modality, completeness of revascularization, and residual SYNTAX scores were not predictors of in-hospital and long-term mortalities, MI, and stroke in real-world practice. R-CABG was associated with lower rates of TLR and TVR, and is likely a safe and effective treatment and an alternative choice of PCI for MVD patients who have low surgical risks.
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Affiliation(s)
- Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Institute of Clinical Medicine, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Ching-Hui Shen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- School of Medicine, National Yang-Ming University, Taipei
| | - Keng-Hao Chang
- Department of Internal Medicine, Cheng Ching Hospital, Taichung
| | - Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Institute of Clinical Medicine, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Kuan-Ju Chen
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tzu-Hsiang Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei
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Song Y, Gao Z, Tang XF, Jiang P, Xu JJ, Yao Y, Li JX, Zhao XY, Qiao SB, Yang YJ, Gao RL, Xu B, Yuan JQ. Impact of Residual SYNTAX Score and Its Derived Indexes on Clinical Outcomes after Percutaneous Coronary Intervention: Data from a Large Single Center. Chin Med J (Engl) 2018; 131:1390-1396. [PMID: 29893355 PMCID: PMC6006821 DOI: 10.4103/0366-6999.233958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Residual SYNTAX score (rSS) and its derived indexes including SYNTAX revascularization index (SRI) and clinical rSS had been developed to quantify and describe the extent of incomplete revascularization. This study was conducted to explore the utility of the three scores among real-world patients after percutaneous coronary intervention (PCI). Methods From January 2013 to December 2013, patients underwent PCI treatment at Fuwai Hospital were included. The primary endpoints were all-cause death and major adverse cardiovascular and cerebrovascular events. The secondary endpoints were myocardial infarction, revascularization, stroke, and stent thrombosis. Kaplan-Meier methodology was used to determine the outcomes. Cox multivariable regression was to test the associations between scores and all-cause mortality. Results A total of 10,344 patients were finally analyzed in this study. Kaplan-Meier survival analysis indicated that greater residual coronary lesions quantified by rSS and its derived indexes were associated with increased risk of adverse cardiovascular events. However, after multivariate analysis, only clinical rSS was an independent predictor of 2-year all-cause death (hazard ratio: 1.02, 95% confidence interval: 1.01-1.03, P < 0.01). By receiver operating characteristic (ROC) curve analysis, clinical rSS had superior predictability of 2-year all-cause death than rSS and SRI (area under ROC curve [AUC]: 0.59 vs. 0.56 vs. 0.56, all P < 0.01), whereas rSS was superior in predicting repeat revascularization than clinical rSS and SRI (AUC: 0.62 vs. 0.61 vs. 0.61; all P < 0.01). When comparing the predictive capability of rSS ≥8 with SRI <70%, their predictabilities were not significantly different. Conclusions This study indicates that all three indexes (rSS, clinical rSS, and SRI) are able to risk-stratify patients and predict 2-year outcomes after PCI. However, their prognostic capabilities are different.
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Affiliation(s)
- Ying Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhan Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiao-Fang Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ping Jiang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jing-Jing Xu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yi Yao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jian-Xin Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xue-Yan Zhao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shu-Bin Qiao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yue-Jin Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Run-Lin Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Bo Xu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jin-Qing Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Javanainen T, Sans-Roselló J, Harjola VP, Nieminen MS, Lassus J, Sionis A, Varpula M, Jurkko R. Prognostic impact of baseline and residual SYNTAX scores in cardiogenic shock. Catheter Cardiovasc Interv 2018; 93:1-8. [DOI: 10.1002/ccd.27716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 04/10/2018] [Accepted: 06/10/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Tuija Javanainen
- Cardiology; University of Helsinki, Heart and Lung Center, Helsinki University Hospital; Helsinki Finland
| | - Jordi Sans-Roselló
- Department of Cardiology, Acute and Intensive Cardiovascular Care Unit; Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat Autònoma de Barcelona, CIBER-CV; Barcelona Spain
| | - Veli-Pekka Harjola
- Emergency Medicine, Department of Emergency Medicine and Services; University of Helsinki, Helsinki University Hospital; Helsinki Finland
| | - Markku S. Nieminen
- Cardiology; University of Helsinki, Heart and Lung Center, Helsinki University Hospital; Helsinki Finland
| | - Johan Lassus
- Cardiology; University of Helsinki, Heart and Lung Center, Helsinki University Hospital; Helsinki Finland
| | - Alessandro Sionis
- Department of Cardiology, Acute and Intensive Cardiovascular Care Unit; Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat Autònoma de Barcelona, CIBER-CV; Barcelona Spain
| | - Marjut Varpula
- Cardiology; University of Helsinki, Heart and Lung Center, Helsinki University Hospital; Helsinki Finland
| | - Raija Jurkko
- Cardiology; University of Helsinki, Heart and Lung Center, Helsinki University Hospital; Helsinki Finland
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Kobayashi Y, Lønborg J, Jong A, Nishi T, De Bruyne B, Høfsten DE, Kelbæk H, Layland J, Nam CW, Pijls NH, Tonino PA, Warnøe J, Oldroyd KG, Berry C, Engstrøm T, Fearon WF. Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS. J Am Coll Cardiol 2018; 72:1321-1329. [DOI: 10.1016/j.jacc.2018.06.069] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/17/2018] [Accepted: 06/20/2018] [Indexed: 11/29/2022]
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Novel predictors of outcome after coronary angioplasty with rotational atherectomy. Not only low ejection fraction and clinical parameters matter. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:42-51. [PMID: 29743903 PMCID: PMC5939544 DOI: 10.5114/aic.2018.74354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/10/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Most established risk factors after rotational atherectomy (RA) of heavily fibro-calcified lesions are associated with patients' general risk and clinical related factors and are not specific for either coronary and culprit lesion anatomy or the RA procedure. Aim To assess novel predictors of poor outcome after percutaneous coronary intervention using RA in an all-comers population. Material and methods A total of 207 consecutive patients after RA were included in a single-center observational study. Primary endpoints were 1-year mortality and 1-year major adverse cardiac events (MACE). Secondary endpoints were angiographic and procedural success and in-hospital complications. Results Procedural complications occurred in 19 (8%) patients. In-hospital mortality was 1%, peri-procedural myocardial infarction (MI) was 9%, and acute stroke occurred in one patient. The 1-year MACE rate was 20% with all-cause mortality 10%, MI 10% and stroke 1%. Multivariable analysis revealed heart failure with left ventricle ejection fraction (LVEF) ≤ 35% (p = 0.02) and uncrossable lesion, as compared to undilatable lesion (p = 0.01), as independent predictors of 1-year mortality and residual SYNTAX score ≤ 8 as an independent predictor of favorable outcome (p = 0.04). Heart failure with LVEF ≤ 35% (p < 0.01) and uncrossable lesion (p = 0.04) were independent predictors of 1-year MACE. Conclusions The presence of a novel factor, uncrossable lesion, as compared to undilatable lesion, is associated with poor outcome, and low residual SYNTAX score ≤ 8 is associated with favorable outcome in 1-year follow-up after the RA procedure and can help in risk stratification of patients undergoing complex coronary intervention with RA.
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Tomizawa N, Yamamoto K, Inoh S, Nojo T, Nakamura S. High-risk Plaque and Calcification Detected by Coronary CT Angiography to Predict Future Cardiovascular Events After Percutaneous Coronary Intervention. Acad Radiol 2018; 25:486-493. [PMID: 29195787 DOI: 10.1016/j.acra.2017.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to investigate whether high-risk plaque (HRP) and calcium assessed by coronary computed tomography (CT) could predict future cardiovascular events after second-generation drug-eluting stent (DES) placement. MATERIALS AND METHODS We analyzed 317 patients from December 2012 to April 2015 who underwent coronary CT followed by DES placement. HRP was defined as a plaque with positive remodeling and low attenuation or a plaque with a napkin-ring sign. Coronary calcium was assessed by Agatston score (AS). Patients were divided into three groups: low risk, HRP negative and AS <400; intermediate risk, HRP positive and AS ≥400; high risk, HRP positive and AS ≥400. The primary end point was a composite of all-cause mortality, myocardial infarction, fatal arrhythmia, or repeated revascularization. Kaplan-Meier analysis was used to estimate the distribution of time to events. RESULTS A total of 74 events (23%) occurred during a median follow-up of 25.8 months. Patients with primary end points had HRP more frequently (70% vs 51%, P = 0.003) and were more calcified (AS, 471 [interquartile range, 143-1614] vs 289 [interquartile range, 63-787]; P = 0.01) than patients without primary end points. The frequency of primary end point increased significantly in the intermediate- and high-risk patients (P = 0.0011). Multivariate analysis showed that the hazard ratio of the intermediate- and high-risk groups was 1.91 (95% confidence interval, 1.04-3.77; P = 0.037) and 2.66 (95% confidence interval, 1.27-5.73; P = 0.009), respectively. CONCLUSION Plaque and calcification analysis by coronary CT could predict future cardiovascular events after second-generation DES placement.
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Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan.
| | - Kodai Yamamoto
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Shinichi Inoh
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Takeshi Nojo
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Matsudo, Chiba, Japan
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Gao G, Feng L, Zhang D, Song C, Zhu C, Song W, Zhao Y, Xu B, Yin D, Dou K. Proximal left anterior descending coronary artery stenosis should be considered when using the prognostic value of the residual SYNTAX score: Data from 10343 consecutive patients with long-term follow up in the real world. Catheter Cardiovasc Interv 2018. [PMID: 29542281 DOI: 10.1002/ccd.27524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the prognostic significance of the residual SYNTAX score (rSS) in a large-scale cohort of consecutive percutaneous coronary intervention (PCI) patients and to analyze whether residual proximal left anterior descending coronary artery (pLAD) lesions affect the prognosis of patients with same or similar rSS levels. BACKGROUND The rSS, measured after PCI, has been assessed as an independent predictor of long-term clinical outcome and a tool for quantification of incomplete revascularization, and still needs to be validated in various PCI populations. When using rSS to determine an objective level of reasonable incomplete revascularization, it is currently undefined whether a pLAD lesion deserves more attention. METHODS The calculations of baseline SYNTAX scores (bSS) and rSS were performed in 10,343 consecutive patients undergoing PCI in Fuwai Hospital from January 2013 to December 2013. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause death, myocardial infarction (MI), and any revascularization. Secondary endpoints included the individual components of the MACE, cardiac death, and all-cause death/MI. RESULTS MACE and cardiac death rates were significantly higher among patients with residual pLAD stenosis ≥70%. rSS and residual pLAD stenosis ≥70% were both strong independent predictors of MACE. Compared with rSS, rSS plus residual pLAD stenosis was superior in predicting 30-month MACE (P = .0016). CONCLUSIONS rSS is a strong independent predictor of long-term adverse clinical outcomes. Residual pLAD lesions affect the prognosis of patients with same or similar rSS levels.
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Affiliation(s)
- Guofeng Gao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Lei Feng
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Dong Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Chenxi Song
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Chenggang Zhu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Weihua Song
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yanyan Zhao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Bo Xu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Dong Yin
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Kefei Dou
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
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Choi KH, Lee JM, Koo BK, Nam CW, Shin ES, Doh JH, Rhee TM, Hwang D, Park J, Zhang J, Kim KJ, Hu X, Wang J, Ye F, Chen S, Yang J, Chen J, Tanaka N, Yokoi H, Matsuo H, Takashima H, Shiono Y, Akasaka T. Prognostic Implication of Functional Incomplete Revascularization and Residual Functional SYNTAX Score in Patients With Coronary Artery Disease. JACC Cardiovasc Interv 2018; 11:237-245. [DOI: 10.1016/j.jcin.2017.09.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/06/2017] [Accepted: 09/13/2017] [Indexed: 11/17/2022]
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Su CS, Chen YW, Shen CH, Liu TJ, Chang Y, Lee WL. Clinical outcomes of left main coronary artery disease patients undergoing three different revascularization approaches. Medicine (Baltimore) 2018; 97:e9778. [PMID: 29443740 PMCID: PMC5839844 DOI: 10.1097/md.0000000000009778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Significant unprotected left main (LM) coronary artery disease is frequently associated with severe multivessel disease and increased mortality and morbidity compared with non-LM coronary artery disease. This study compared the clinical outcomes of patients with LM disease who received percutaneous coronary intervention (PCI) with stenting, conventional coronary-artery bypass grafting (C-CABG), and robot-assisted CABG (R-CABG).This retrospective study analyzed 472 consecutive LM disease patients who underwent three different revascularization approaches at a tertiary medical center between January 2005 and November 2013.Of the 472 LM disease patients, 139 received R-CABG, 147 received C-CABG, and 186 received PCI. The need for target vessel revascularization (TVR) was highest in the PCI group. The R-CABG group had significantly lower rates of in-hospital and follow-up all-cause deaths compared with the other 2 groups (1.4% vs. 3.4% and 9.7%, P = .0058; 13.7% vs. 29.3% and 29.6%, P = .0023, respectively). Patients in the R-CABG group had significantly lower rates of intra-aortic balloon pump assistance, and shorter duration of ICU and total hospital stay compared to patients in the C-CABG group. However, revascularization modality, SYNTAX scores, and residual SYNTAX scores were not independent predictors of in-hospital or long-term mortality.In this cohort of LM disease patients treated at a tertiary medical center, PCI is a reasonable choice in patients with less lesion complexity but who are older and have comorbidities. R-CABG is feasible in stable LM disease patients with high SYNTAX scores, and is an effective alternative to C-CABG in LM disease patients with few risk factors. However, revascularization modality per se was not a determinant for long-term mortality in our real-world practice.
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Affiliation(s)
- Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Institute of Clinical Medicine, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Division of Cardiology, Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi
| | - Ching-Hui Shen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- Department of Surgery
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Surgery
- Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Yen Chang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Surgery
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Surgery
- Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
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Song Y, Gao Z, Tang X, Jiang P, Xu J, Yao Y, Li J, Zhao X, Qiao S, Yang Y, Gao R, Xu B, Yuan J. Impact of residual SYNTAX score on clinical outcomes after incomplete revascularisation percutaneous coronary intervention: a large single-centre study. EUROINTERVENTION 2017; 13:1185-1193. [DOI: 10.4244/eij-d-17-00132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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He C, Song Y, Wang CS, Yao Y, Tang XF, Zhao XY, Gao RL, Yang YJ, Xu B, Yuan JQ. Prognostic Value of the Clinical SYNTAX Score on 2-Year Outcomes in Patients With Acute Coronary Syndrome Who Underwent Percutaneous Coronary Intervention. Am J Cardiol 2017; 119:1493-1499. [PMID: 28341359 DOI: 10.1016/j.amjcard.2017.02.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/19/2022]
Abstract
This prospective, single-center, observational study evaluated prognostic value of clinical SYNTAX score (CSS) on 2-year outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). The SYNTAX score (SS) is a scoring system based on the complexity and severity of coronary lesions and is thought to be a prognostic tool to predict long-term outcomes. However, SS was a sole angiographic grading tool only with no consideration for clinical factors. There are few studies investigating the prognostic value of CSS in patients with ACS who underwent PCI. From January 2013 to December 2013, 6,099 consecutive patients with ACS admitted to FuWai hospital and underwent PCI were enrolled in this study. Based on CSS, patients were divided into low CSS group (CSS ≤ 6.5; 2,012 patients), mid-CSS group (6.5 < CSS < 13.8; 2,056 patients), and high CSS group (CSS ≥ 13.8; 2,031 patients). At 2-year follow-up, rates of cardiac death and major adverse cardiac events (MACE) were significantly higher in the high CSS group. Compared with baseline SS, CSS demonstrated significantly improved performance for 2-year cardiac death (receiver-operating characteristic curve C-statistic: 0.74 vs 0.62, p <0.001) but not for MACE (receiver-operating characteristic curve C-statistic: 0.60 vs 0.59, p = 0.29). By multivariable analysis, the CSS combined with PCI history and hypertension were strong predictors for cardiac death and CSS, intra-aortic balloon pump support, diabetes, and successful PCI were independent predictors for MACE. In conclusion, compared with the anatomic SS, CSS was suitable in risk stratifying and predicting 2-year clinical outcome among ACS population.
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Affiliation(s)
- Chen He
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuang-Shi Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Yao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Fang Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Yan Zhao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Run-Lin Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Jin Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jin-Qing Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Kearney K, Hira RS, Riley RF, Kalyanasundaram A, Lombardi WL. Update on the Management of Chronic Total Occlusions in Coronary Artery Disease. Curr Atheroscler Rep 2017; 19:19. [DOI: 10.1007/s11883-017-0655-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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27
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Nagaraja V, Ooi SY, Nolan J, Large A, De Belder M, Ludman P, Bagur R, Curzen N, Matsukage T, Yoshimachi F, Kwok CS, Berry C, Mamas MA. Impact of Incomplete Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2016; 5:JAHA.116.004598. [PMID: 27986755 PMCID: PMC5210416 DOI: 10.1161/jaha.116.004598] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Up to half of patients undergoing percutaneous coronary intervention have multivessel coronary artery disease (MVD) with conflicting data regarding optimal revascularization strategy in such patients. This paper assesses the evidence for complete revascularization (CR) versus incomplete revascularization in patients undergoing percutaneous coronary intervention, and its prognostic impact using meta‐analysis. Methods and Results A search of PubMed, EMBASE, MEDLINE, Current Contents Connect, Google Scholar, Cochrane library, Science Direct, and Web of Science was conducted to identify the association of CR in patients with multivessel coronary artery disease undergoing percutaneous coronary intervention with major adverse cardiac events and mortality. Random‐effects meta‐analysis was used to estimate the odds of adverse outcomes. Meta‐regression analysis was conducted to assess the relationship with continuous variables and outcomes. Thirty‐eight publications that included 156 240 patients were identified. Odds of death (OR 0.69, 95% CI 0.61‐0.78), repeat revascularization (OR 0.60, 95% CI 0.45‐0.80), myocardial infarction (OR 0.64, 95% CI 0.50‐0.81), and major adverse cardiac events (OR 0.63, 95% CI 0.50‐0.79) were significantly lower in the patients who underwent CR. These outcomes were unchanged on subgroup analysis regardless of the definition of CR. Similar findings were recorded when CR was studied in the chronic total occlusion (CTO) subgroup (OR 0.65, 95% CI 0.53‐0.80). A meta‐regression analysis revealed a negative relationship between the OR for mortality and the percentage of CR. Conclusion CR is associated with reduced risk of mortality and major adverse cardiac events, irrespective of whether an anatomical or a score‐based definition of incomplete revascularization is used, and this magnitude of risk relates to degree of CR. These results have important implications for the interventional management of patients with multivessel coronary artery disease.
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Affiliation(s)
- Vinayak Nagaraja
- Department of Cardiology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sze-Yuan Ooi
- Department of Cardiology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - James Nolan
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom.,Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, United Kingdom
| | - Adrian Large
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
| | - Mark De Belder
- The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Peter Ludman
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine and Department of Epidemiology & Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nick Curzen
- University Hospital Southampton & Faculty of Medicine University of Southampton, United Kingdom
| | - Takashi Matsukage
- Division of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | | | - Chun Shing Kwok
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom.,Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, United Kingdom
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Mamas A Mamas
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom .,Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, United Kingdom
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Kang J, Park KW, Han JK, Yang HM, Kang HJ, Koo BK, Kim HS. Usefulness of the Baseline Syntax Score to Predict 3-Year Outcome After Complete Revascularization by Percutaneous Coronary Intervention. Am J Cardiol 2016; 118:641-6. [PMID: 27394412 DOI: 10.1016/j.amjcard.2016.06.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 01/06/2023]
Abstract
Although we strive to achieve complete revascularization (CR) in those receiving percutaneous coronary intervention, it is uncertain which of these patients are at increased risk of clinical events. In this study, we aimed to investigate whether the baseline SYNTAX score (bSS) can predict adverse clinical events in patients receiving CR. From the Efficacy of Xience/Promus Versus Cypher in Reducing Late Loss After Stenting registry, the 3-year patient-oriented composite end point (POCE; all cause death, any myocardial infarction, and any revascularization) was compared according to bSS tertiles (1 ≤ low bSS < 6, 6 ≤ mid-bSS < 10, high bSS ≥ 10). Of the 5,088 patients, CR was achieved in 2,173 by percutaneous coronary intervention. The 3-year POCE increased significantly along with bSS tertile (7.3% vs 8.4% vs 14.8%, p <0.001). Multivariate analysis showed that, despite having the same residual SS of 0, the bSS was an independent predictor of 3-year POCE (hazard ratio 1.038, 95% confidence interval 1.018 to 1.058, p <0.001 per bSS point). In subgroup analysis, bSS was a predictor for 3-year POCE in multivessel diseases (hazard ratio 1.029, 95% confidence interval 1.004 to 1.054, p = 0.025 per bSS point), whereas in single-vessel diseases, the discriminative value of bSS was less significant. Also the clinical SYNTAX score, which added age, creatinine level, and ejection fraction to the bSS, was superior to the bSS in predicting 3-year POCE (area under the curve 0.595 vs 0.649, p = 0.008). In conclusion, the bSS was an independent predictor of long-term clinical outcomes in patients receiving CR, especially in those with multivessel coronary artery disease. Adding clinical factors to the bSS could increase the predictive power of clinical outcomes.
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Kobayashi Y, Nam CW, Tonino PAL, Kimura T, De Bruyne B, Pijls NHJ, Fearon WF. The Prognostic Value of Residual Coronary Stenoses After Functionally Complete Revascularization. J Am Coll Cardiol 2016; 67:1701-11. [PMID: 27056776 DOI: 10.1016/j.jacc.2016.01.056] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/19/2016] [Accepted: 01/29/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The residual SYNTAX score (RSS) and SYNTAX revascularization index (SRI) quantitatively assess angiographic completeness of revascularization for patients with multivessel coronary artery disease. Whether residual angiographic disease remains of prognostic importance after "functionally" complete revascularization with fractional flow reserve (FFR) guidance is unknown. OBJECTIVES This study sought to investigate the prognostic value of the RSS and SRI after FFR-guided functionally complete revascularization. METHODS From the FFR-guided percutaneous coronary intervention (PCI) cohort of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) trial, the RSS and SRI were calculated in 427 patients after functionally complete revascularization. The RSS was defined as the SYNTAX score (SS) recalculated after PCI. The SRI was calculated as: 100 × (1 - RSS/baseline SS) (%). We compared differences in 1- and 2-year outcomes among patients with RSS of 0, >0 to 4, >4 to 8, and >8, and with SRI of 100%, 50% to <100%, and 0 to <50%. RESULTS The mean baseline SS, RSS, and SRI were 14.4 ± 7.2, 6.5 ± 5.8, and 55.1 ± 32.5%, respectively. Major adverse cardiac events (MACE) at 1 year occurred in 53 patients (12.4%). Patients with MACE had higher SS than those without (18.0 [interquartile range (IQR): 11.0 to 21.0] vs. 12.0 [IQR: 9.0 to 18.0], p = 0.001), but had similar RSS and SRI after PCI (RSS: 6.0 [IQR: 3.0 to 10.0] vs. 5.0 [IQR: 2.0 to 9.5], p = 0.51 and SRI: 60.0% [IQR: 40.9% to 78.9%] vs. 58.8% [IQR: 26.7% to 81.8%], p = 0.24, respectively). Kaplan-Meier analysis showed similar 1-year incidence of MACE with RSS/SRI stratifications (log-rank p = 0.55 and p = 0.54, respectively). Results were similar with 2-year outcome data analysis. CONCLUSIONS After functionally complete revascularization with FFR guidance, residual angiographic lesions that are not functionally significant do not reflect residual ischemia or predict a worse outcome, supporting functionally complete, rather than angiographically complete, revascularization. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [FAME]; NCT00267774).
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Affiliation(s)
- Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford University, Stanford, California; Stanford Cardiovascular Institute, Stanford, California
| | - Chang-Wook Nam
- Keimyung University College of Medicine, Dongsan Medical Center, Daegu, South Korea
| | | | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford University, Stanford, California; Stanford Cardiovascular Institute, Stanford, California
| | | | | | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University, Stanford, California; Stanford Cardiovascular Institute, Stanford, California.
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Alidoosti M, Saroukhani S, Lotfi-Tokaldany M, Jalali A, Sobh-Rakhshankhah A. Objectifying the level of incomplete revascularization by the residual SYNTAX score and evaluating its impact on the one-year outcome of percutaneous coronary intervention in patients with multi-vessel disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:308-12. [PMID: 27198530 DOI: 10.1016/j.carrev.2016.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/12/2016] [Accepted: 03/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies reported conflicting results regarding the impact of incomplete revascularization on the outcome of percutaneous coronary intervention (PCI). We evaluated the association between residual SYNTAX score (RSS) as a quantitative measure of incomplete revascularization and one-year outcome of patients with native multi-vessel disease undergoing PCI. METHODS A total of 760 patients (mean age=59.14±10.36years, 70.4% males) who underwent successful PCI with the incomplete revascularization strategy between September 2008 and March 2010 were included. The RSS was used to quantify the extent and complexity of residual coronary stenosis following PCI. Multivariable analysis was used to evaluate the impact of RSS on one-year major adverse cardiac events (MACE) including death, myocardial infarction, and revascularization. RESULTS Overall incidence of one-year MACE was 4.74%. Using ROC curve analysis a cut-off of >5 for baseline RSS had a significant association with occurrence of 12-month MACE (area under the curve=0.769; P value<0.001, sensitivity =75% and specificity=72%). Unadjusted effect of RSS>5 on 12months MACE showed a hazard ratio of 7.34 (p value<0.001). By multivariable analysis, effect of the RSS>5 on 12months MACE was adjusted for potential confounders. After adjustment to clinical SYNTAX score as the sole confounder, RSS>5 remained a strong associate with 12months MACE and its effect outweighed that of before adjustment (hazard ratio=8.03, p value<0.001). CONCLUSIONS The RSS is a quantified measure of the complexity of residual coronary stenoses, and RSS>5 could be able to discriminate patients with an increased risk of one-year MACE.
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Affiliation(s)
- Mohammad Alidoosti
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran.
| | - Sepideh Saroukhani
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran.
| | - Masoumeh Lotfi-Tokaldany
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran.
| | - Arash Jalali
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran.
| | - Amir Sobh-Rakhshankhah
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran.
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