 |
|
| What is the Role of Complex Coronary Anatomy in Modern Bypass Surgery? Lessons Learned from the Syntax Trial After Two Years | |||||||||||||||||||||||||||||||||||
|
Friedrich W. Mohr1, Ardawan J. Rastan1, Patrick W. Serruys2, A. Pieter Kappetein2, Elisabeth Stahle3, David R. Holmes4, Jose L. Pomar5, Stephen Westaby6, Katrin Leadley7, Keith D. Dawkins7, Michael J. Mack8 1Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany; 2Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands; 3University Hospital Uppsala, Uppsala, Sweden; 4Mayo Clinic, Rochester, MN; 5Hospital Clinico y Provincial, Barcelona, Spain; 6John Radcliffe Infirmary Oxford II, Oxford, United Kingdom; 7Boston Scientific Corporation, Natick, MA; 8Medical City Hospital, Dallas, TX Objective: SYNTAX is a prospective, multicenter trial comparing the outcome of CABG with PCI in patients with 3-vessel and/or left main disease. Complexity of coronary arterial anatomy and disease was analyzed by a scoring system, the SYNTAX Score. The SYNTAX Score is a composite of 9 characteristics (eg, number and location of lesions, tortuosity, calcification, etc.) of each significant lesion. This study investigates whether the complexity of coronary disease as defined by the SYNTAX Score impacts CABG outcomes. Methods: Patients from the CABG randomized (RCT) and registry arms of the trial were included in the analysis. Patients were stratified according to their SYNTAX Score into 3 groups: low (0-22), medium (23-32), and high (33 and above) complexity. Clinical outcomes at 12-24 months post allocation were determined for each group. Results: Of the 3075 patients enrolled in SYNTAX, 1541 underwent CABG (897 and 644 in the randomized and registry cohorts, respectively). Patients enrolled in the registry had more complex disease than those in the RCT (mean total SYNTAX Score±SD: registry, 37.8±13.3; RCT, 29.1±11.4). At 30 days, mortality was 0.9% (combined groups: 14/1507; RCT: 1.2% [10/866]; registry: 0.6% [4/641]). Major adverse cardiac and cerebrovascular events (MACCE) at 30 days was 4.4% (combined groups: 67/1507; RCT: 5.2% [45/866]; registry: 3.4% [22/641]). At 12 months, compared with RCT patients, patients enrolled in the registry had lower mortality (2.5% [16/633] vs 3.5% [30/849], registry vs RCT) and symptomatic post procedure graft occlusion (2.0% [12/612] vs 3.4% [27/787], registry vs RCT); however, cerebrovascular accident rates were comparable (2.2% [14/633] vs 2.2 [19/849], registry vs RCT). The 24-month results of the pooled group (RCT and registry arms) are contained in the Table. Patients with low, medium, and high SYNTAX Scores had similar overall MACCE outcomes and no significant differences in safety outcomes. Conclusion: Outcomes of CABG were excellent independent of the SYNTAX Score. Higher degrees of coronary disease complexity did not impact CABG outcomes, in contrast to PCI. Repeat revascularisation, CVA, and MI rarely occurred in the second year. CABG Outcomes According to SYNTAX Score
CVA=cerebrovascular accident; MACCE=major adverse cardiovascular and cerebrovascular events; MI=myocardial infarction. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
We Model Excellence |
|
Copyright © 2012 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.