A Global Risk Approach to Identify Patients With Left Main or 3-Vessel Disease Who Could Safely and Efficaciously Be Treated With Percutaneous Coronary Intervention: The SYNTAX Trial at 3 Years

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• 作者：Patrick W. Serruys ; MD ; PhD^鈦?/sup> ; ^{p.w.j.c.serruys@erasmusmc.nl} ; Vasim Farooq ; MBchB^鈦?/sup> ; Pascal Vranckx ; MD^鈦?/sup> ; Chrysafios Girasis ; MD^鈦?/sup> ; Salvatore Brugaletta ; MD^鈦?/sup> ; Hector M. Garcia-Garcia ; MD^鈦?/sup> ; David R. Holmes Jr ; MD^&dagger ; ; Arie-Pieter Kappetein ; MD ; PhD^&Dagger ; ; Michael J. Mack ; MD^§ ; ; Ted Feldman ; MD^鈭?/sup> ; Marie-Claude Morice ; MD^¶ ; ; Elisabeth Stå ; hle ; MD^# ; Stefan James ; MD^# ; Antonio Colombo ; MD^鈦庘亷 ; Peggy Pereda ; MS^&dagger ; &dagger ; ; Jian Huang ; MD ; MS^&dagger ; &dagger ; ; Marie-Angè ; le Morel ; BSc^&Dagger ; &Dagger ; ; Gerrit-Anne Van Es ; PhD^&Dagger ; &Dagger ; ; Keith D. Dawkins ; MD^&dagger ; &dagger ; ; Friedrich W. Mohr ; MD^§ ; § ; ; Ewout W. Steyerberg ; PhD^鈭モ垾
• 关键词：3-vessel disease ; Global Risk ; left main disease ; SYNTAX Score
• 刊名：JACC ; Cardiovascular Interventions
• 出版年：2012
• 期刊代码：pca198_19368798
• 类别：med
• 出版时间：June, 2012
• 卷：5
• 期：6
• 页码：606-617
• 文件大小：3205 K

摘要

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Objectives

The aim of this study was to assess the additional value of the Global Risk鈥攁 combination of the SYNTAX Score (SXscore) and additive EuroSCORE鈥攊n the identification of a low-risk population, who could safely and efficaciously be treated with coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI).

Background

PCI is increasingly acceptable in appropriately selected patients with left main stem or 3-vessel coronary artery disease.

Methods

Within the SYNTAX Trial (Synergy between PCI with TAXUS and Cardiac Surgery Trial), all-cause death and major adverse cardiac and cerebrovascular events (MACCE) were analyzed at 36 months in low (GRC_LOW) to high Global Risk groups, with Kaplan-Meier, log-rank, and Cox regression analyses.

Results

Within the randomized left main stem population (n = 701), comparisons between GRC_LOW groups demonstrated a significantly lower mortality with PCI compared with CABG (CABG: 7.5%, PCI: 1.2%, hazard ratio [HR]: 0.16, 95%confidence interval [CI]: 0.03 to 0.70, p = 0.0054) and a trend toward reduced MACCE (CABG: 23.1%, PCI: 15.8%, HR: 0.64, 95%CI: 0.39 to 1.07, p = 0.088). Similar analyses within the randomized 3-vessel disease population (n = 1,088) demonstrated no statistically significant differences in mortality (CABG: 5.2%, PCI: 5.8%, HR: 1.14, 95%CI: 0.57 to 2.30, p = 0.71) or MACCE (CABG: 19.0%, PCI: 24.7%, HR: 1.35, 95%CI: 0.95 to 1.92, p = 0.10). Risk-model performance and reclassification analyses demonstrated that the EuroSCORE鈥攚ith the added incremental benefit of the SXscore to form the Global Risk鈥攅nhanced the risk stratification of all PCI patients.

Conclusions

In comparison with the SXscore, the Global Risk, with a simple treatment algorithm, substantially enhances the identification of low-risk patients who could safely and efficaciously be treated with CABG or PCI.