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Banning AP, Serruys P, De Maria GL, Ryan N, Walsh S, Gonzalo N, Jan van Geuns R, Onuma Y, Sabate M, Davies J, Lesiak M, Moreno R, Cruz-Gonzalez I, Hoole SP, Piek JJ, Appleby C, Fath-Ordoubadi F, Zaman A, Van Mieghem NM, Uren N, Zueco J, Buszman P, Iniguez A, Goicolea J, Hildick-Smith D, Ochala A, Dudek D, de Vries T, Taggart D, Farooq V, Spitzer E, Tijssen J, Escaned J. Five-year outcomes after state-of-the-art percutaneous coronary revascularization in patients with de novo three-vessel disease: final results of the SYNTAX II study. Eur Heart J 2021; 43:1307-1316. [PMID: 34617993 PMCID: PMC8970987 DOI: 10.1093/eurheartj/ehab703] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/24/2021] [Accepted: 09/14/2021] [Indexed: 11/14/2022] Open
Abstract
Aims The SYNTAX II study evaluated the impact of advances in percutaneous coronary intervention (PCI), integrated into a single revascularization strategy, on outcomes of patients with de novo three-vessel disease. The study employed decision-making utilizing the SYNTAX score II, use of coronary physiology, thin-strut biodegradable polymer drug-eluting stents, intravascular ultrasound, enhanced treatments of chronic total occlusions, and optimized medical therapy. Patients treated with this approach were compared with predefined patients from the SYNTAX I trial. Methods and results SYNTAX II was a multicentre, single-arm, open-label study of patients requiring revascularization who demonstrated clinical equipoise for treatment with either coronary artery bypass grafting (CABG) or PCI, predicted by the SYNTAX score II. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), which included any revascularization. The comparators were a matched PCI cohort trial and a matched CABG cohort, both from the SYNTAX I trial. At 5 years, MACCE rate in SYNTAX II was significantly lower than in the SYNTAX I PCI cohort (21.5% vs. 36.4%, P < 0.001). This reflected lower rates of revascularization (13.8% vs. 23.8%, P < 0.001), and myocardial infarction (MI) (2.7% vs. 10.4%, P < 0.001), consisting of both procedural MI (0.2% vs. 3.8%, P < 0.001) and spontaneous MI (2.3% vs. 6.9%, P = 0.004). All-cause mortality was lower in SYNTAX II (8.1% vs. 13.8%, P = 0.013) reflecting a lower rate of cardiac death (2.8% vs. 8.4%, P < 0.001). Major adverse cardiac and cerebrovascular events’ outcomes at 5 years among patients in SYNTAX II and predefined patients in the SYNTAX I CABG cohort were similar (21.5% vs. 24.6%, P = 0.35). Conclusions Use of the SYNTAX II PCI strategy in patients with de novo three-vessel disease led to improved and durable clinical results when compared to predefined patients treated with PCI in the original SYNTAX I trial. A predefined exploratory analysis found no significant difference in MACCE between SYNTAX II PCI and matched SYNTAX I CABG patients at 5-year follow-up.
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Affiliation(s)
- Adrian P Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Oxford OX3 9DU, UK
| | - Patrick Serruys
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Giovanni Luigi De Maria
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Oxford OX3 9DU, UK
| | - Nicola Ryan
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid 28040, Spain
| | - Simon Walsh
- Department of Cardiology, Belfast Health & Social Care Trust, Belfast BT8*BH, UK
| | - Nieves Gonzalo
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid 28040, Spain
| | | | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Manel Sabate
- Cardiovascular Institute, Hospital Clinic I Provincial de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV) CB16/11/00411, Barcelona Spain
| | - Justin Davies
- Department of Cardiology, Imperial College London, Kensington, London SW7 2AZ, UK
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences, Poznan 61-701, Poland
| | - Raul Moreno
- Department of Cardiology, Hospital Universitario la Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Ignacio Cruz-Gonzalez
- Department of Cardiology, Hospital Universitario de Salamanca, IBSAL, Paseo de San Vicente, 58, Salamanca 37007, Spain
| | - Stephen P Hoole
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK
| | - Jan J Piek
- Department of Cardiology, Academic Medical Center of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Clare Appleby
- Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool L14 3PE, UK
| | - Farzin Fath-Ordoubadi
- Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals, Oxford Rd, Manchester M13 9WL, UK
| | - Azfar Zaman
- Department of Cardiology, Freeman Hospital and Newcastle University, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Neal Uren
- Department of Cardiology, The Royal Infirmary of Edinburgh, 51 Little France Dr, Edinburgh EH16 4SA, UK
| | - Javier Zueco
- Department of Cardiology, Hospital Universitario Valdecilla, Av. Valdecilla, 25, Santander, Cantabria 39008, Spain
| | - Pawel Buszman
- Department of Cardiology, American Heart of Poland (PAK), Sanatoryjna 1, Ustron 43-450, Poland
| | - Andres Iniguez
- Department of Cardiology, Hospital Álvaro Cunqueiro, c/Clara Campoamor 341, Vigo 36213, Spain
| | - Javier Goicolea
- Department of Cardiology, Hospital Puerta de Hierro, C. Joaquín Rodrigo, 1, Majadahonda 28222, Madrid, Spain
| | - David Hildick-Smith
- Department of Cardiology, Brighton & Sussex University Hospitals NHS Trust, Barry Building, Eastern Rd, Brighton BN2 5BE, UK
| | - Andrzej Ochala
- Department of Cardiology, Gornoslaskie Centrum Medycnze, 45/47, Katowice 40-635, Poland
| | - Dariusz Dudek
- Department of Interventional Cardiology, Jagiellonian University, Gołe, bia 24, Krakow 31-007, Poland
| | - Ton de Vries
- Cardialysis BV, Westblaak 98, 3012 KM Rotterdam, The Netherlands
| | - David Taggart
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Oxford OX3 9DU, UK
| | - Vasim Farooq
- Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals, Oxford Rd, Manchester M13 9WL, UK
| | - Ernest Spitzer
- Cardialysis BV, Westblaak 98, 3012 KM Rotterdam, The Netherlands.,European Cardiovascular Research Institute, Westblaak 98, 3012 KM Rotterdam, The Netherlands
| | - Jan Tijssen
- European Cardiovascular Research Institute, Westblaak 98, 3012 KM Rotterdam, The Netherlands
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid 28040, Spain
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