OBJECTIVES: The aim of this study was to assess the additional value of the Global Risk--a combination of the SYNTAX Score (SXscore) and additive EuroSCORE--in 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-with the added incremental benefit of the SXscore to form the Global Risk-enhanced 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.
RCT Entities:
OBJECTIVES: The aim of this study was to assess the additional value of the Global Risk--a combination of the SYNTAX Score (SXscore) and additive EuroSCORE--in 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-with the added incremental benefit of the SXscore to form the Global Risk-enhanced 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.
Authors: Maciej T Wybraniec; Paweł Bańka; Tomasz Bochenek; Tomasz Roleder; Katarzyna Mizia-Stec Journal: Cardiol J Date: 2020-09-28 Impact factor: 2.737
Authors: Javier Escaned; Carlos Collet; Nicola Ryan; Giovanni Luigi De Maria; Simon Walsh; Manel Sabate; Justin Davies; Maciej Lesiak; Raul Moreno; Ignacio Cruz-Gonzalez; Stephan P Hoole; Nick Ej West; J J Piek; Azfar Zaman; Farzin Fath-Ordoubadi; Rodney H Stables; Clare Appleby; Nicolas van Mieghem; Robert Jm van Geuns; Neal Uren; Javier Zueco; Pawel Buszman; Andres Iñiguez; Javier Goicolea; David Hildick-Smith; Andrzej Ochala; Dariusz Dudek; Colm Hanratty; Rafael Cavalcante; Arie Pieter Kappetein; David P Taggart; Gerrit-Anne van Es; Marie-Angèle Morel; Ton de Vries; Yoshinobu Onuma; Vasim Farooq; Patrick W Serruys; Adrian P Banning Journal: Eur Heart J Date: 2017-11-07 Impact factor: 29.983