ABSTRACT
UNLABELLED: Numerous risk scores have been designed to predict the outcome of percutaneous coronary intervention (PCI). The Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score has been shown to predict outcome in patients with severe coronary artery disease (CAD) randomized to PCI or bypass surgery, but its utility in patients with less severe CAD is less well established. METHODS: We calculated the SYNTAX score in 482 patients with diabetes mellitus or chronic kidney disease (serum creatinine > 1.5 mg/ml) undergoing non-emergency PCI. The study endpoint was 3-year all-cause mortality or repeat revascularization. RESULTS: The mean age was 69 ± 11 years, 44% were women, 82% had diabetes and they had 1.82 ± 0.78 diseased vessels. The mean creatinine clearance was 67.3 ± 37.2 ml/min. The mean SYNTAX score was 11 ± 8, median of 9 (5-15), tertiles < 7, 7-12 and > 12. There was good interobserver concordance (0.784 and 0.816, p < 0.01, respectively among two pairs of observers). The 3-year estimated survival rate was 0.85 (95% confidence interval [CI] 0.82-0.88). By multivariable analysis, creatinine clearance (hazard ratio [HR] 0.82 per 10 ml/min, p < 0.001), ejection fraction (HR 0.82 per 10%, p = 0.004) and prior infarction (HR 1.7, p = 0.03) were the only predictors of death. The SYNTAX score did not predict mortality. The incidence of repeat PCI by increasing tertiles of SYNTAX score was 19.2%, 32.2% and 33.2%, respectively, p < 0.001. CONCLUSION: In patients at high risk for ischemic events without severe CAD, the SYNTAX score is not associated with mortality at 3 years.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Severity of Illness Index , Aged , Aged, 80 and over , Chronic Disease , Coronary Artery Disease/mortality , Diabetes Complications/complications , Female , Humans , Kidney Diseases/complications , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/epidemiology , Prospective Studies , Retrospective Studies , Risk Factors , Survival Rate , Treatment OutcomeABSTRACT
AIMS: To relate late lumen loss (LLL) after drug-eluting stent (DES) implantation to angiographic (BAR) and target vessel revascularization (TVR) in randomized clinical trials of DES. METHODS AND RESULTS: We reviewed all clinical trials comparing different DES and having protocol-driven angiographic follow-up. We combined the data in a meta-regression analysis correlating LLL with BAR or TVR, with and without adjustment for diabetes mellitus, lesion length or reference vessel diameter. There were 15,846 patients in 29 trials (9 DES platforms) and 8697 had angiographic follow-up at a mean of 8 months. The mean age was 63 y, 28% were women and 33% had diabetes mellitus. Mean weighted in-segment LLL was 0.232mm (0.228-0.235mm), significantly higher in paclitaxel- and zotarolimus-eluting stents than in sirolimus-, everolimus- or biolimus-eluting stents. LLL was monotonically related to BAR (BAR=0.30×LLL+0.02, R(2)=0.53, P<0.0001) and TVR (TVR=0.20×LLL+0.02, R(2)=0.46, P<0.0001). Two thirds of patients with BAR had TVR. LLL remained significantly associated with BAR and TVR after multivariable adjustment. Reference vessel diameter and diabetes mellitus were inversely related to BAR. CONCLUSIONS: LLL is a strong, monotonically related predictor of BAR and TVR. There is no evidence of threshold phenomenon in these relationships.
