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Salvatore A, Boukhris M, Giubilato S, Tomasello SD, Castaing M, Giunta R, Marzà F, Abdelbasset HM, Khamis H, Galassi AR. Usefulness of SYNTAX score II in complex percutaneous coronary interventions in the setting of acute coronary syndrome. J Saudi Heart Assoc 2016; 28:63-72. [PMID: 27053895 PMCID: PMC4803775 DOI: 10.1016/j.jsha.2015.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/10/2015] [Accepted: 07/21/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND SYNTAX score II (SS II) integrates anatomical SS with clinical characteristics allowing an individualized prediction of long-term mortality. AIMS We sought to assess to evaluate the usefulness of SS II in a real-world acute coronary syndromes (ACS) population with severe coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). METHODS From August 2011 to May 2013, out of 1591 consecutive patients admitted for ACS, 217 (13.6%) showed severe CAD (three-vessel disease and/or left main involvement). Among the latter, 100 patients underwent PCI and were enrolled into the study. SS II was calculated in all patients. One-year clinical follow-up was performed; major adverse cardiac and cerebrovascular events (MACCE) were defined as a composite of death, nonfatal myocardial infarction, stroke, or repeat revascularization. RESULTS The median SS II was 29 (range, 14-59). Overall, MACCE occurred in 25% of patients (cardiac death 4%, myocardial infarction 4%, stroke 0%, and repeat revascularization 17%). The 1-year MACCE-free survival was significantly lower in patients with SS (⩾29), than in those with SS II (<29) (64.2% vs. 87.2%, respectively; p = 0.007). In multivariate Cox regression analysis, the presence of unprotected left main stenosis [hazard ratio 2.52, 95% confidence interval (CI): 1.02-5.85; p = 0.031] and SS II ⩾29 (hazard ratio 2.74, 95% CI: 1.30-8.21; p = 0.011) were the only predictors of MACCE at 1-year clinical follow-up. The c-index of SS score II was 0.70 (95% CI: 0.58-0.81). For patients who experienced MACCE, the SS II reclassification improved by 36%, while in nonevent patients the reclassification improved by 22%. The net reclassification index was 0.24 (p = 0.09). CONCLUSION SS II might represent a useful tool to predict clinical events in not only ideal stable patients, but also an unrestricted, real world population of patients with ACS and severe CAD undergoing PCI.
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Affiliation(s)
- Azzarelli Salvatore
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
| | - Marouane Boukhris
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
- Faculty of Medicine of Tunis,University of Tunis El Manar, Tunisia
| | - Simona Giubilato
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
| | - Salvatore Davide Tomasello
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
| | - Marine Castaing
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
| | - Rocco Giunta
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
| | - Francesco Marzà
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
| | - Hosam Mohamad Abdelbasset
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
- Maadi Military Hospital, Military Medical Academy, Cairo, Egypt
| | | | - Alfredo Ruggero Galassi
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy
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Boukhris M, Azzarelli S, Tomasello SD, Elhadj ZI, Marzà F, Galassi AR. The GuideLiner Catheter: A Useful Tool in the Armamentarium of the Interventional Cardiologist. J Tehran Heart Cent 2015; 10:208-14. [PMID: 26985211 PMCID: PMC4791651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Regardless of the clinical setting, a good back-up represents one of the most important conditions to ensure guide wire and balloon advancement and stent delivery. As a "mother and child" system, the GuideLiner catheter (Vascular Solutions Inc., Minneapolis, MN, USA) provides an extension to the guide catheter with better coaxial alignment and stability. We report two didactic cases showing the usefulness of the GuideLiner device in everyday catheterization laboratory practice. The first case was a primary percutaneous coronary intervention (PCI) in a 71-year-old diabetic man admitted for inferior ST-elevation myocardial infarction, related to tight proximal stenosis in a dominant tortuous and calcified left circumflex. The second case was an elective PCI in a 76-year-old man admitted for stable angina (Canadian Cardiovascular Society [CCS] class III), related to focal intra-stent restenosis of a saphenous venous graft to the left anterior descending. In both cases, the GuideLiner catheter provided a good back-up insuring the success of PCI and drug-eluting stents implantation, with a good in-hospital outcome.
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Affiliation(s)
- Marouane Boukhris
- Cannizzaro Hospital, University of Catania, Catania, Italy.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | | | | | - Zied Ibn Elhadj
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | | | - Alfredo R. Galassi
- Cannizzaro Hospital, University of Catania, Catania, Italy.,Corresponding Author: Alfredo R. Galassi, Professor of Cardiology, Via Antonello da Messina 75, Acicastello, 95021 Catania, Italy. Tel: +39 95 7263122. Fax: +39 95 7263124. Secretariat: ..
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Tomasello SD, Boukhris M, Ganyukov V, Galassi AR, Shukevich D, Haes B, Kochergin N, Tarasov R, Popov V, Barbarash L. Outcome of extracorporeal membrane oxygenation support for complex high-risk elective percutaneous coronary interventions: A single-center experience. Heart Lung 2015; 44:309-13. [DOI: 10.1016/j.hrtlng.2015.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 01/09/2023]
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