Rodrigo B Esper1, Michael E Farkouh2, Expedito E Ribeiro3, Whady Hueb3, Michael Domanski4, Taye H Hamza5, Flora S Siami5, Lucas Colombo Godoy6, Verghese Mathew7, John French8, Valentin Fuster9. 1. Heart Institute of the University of São Paulo Medical School, São Paulo, Brazil; Prevent Senior Institute, São Paulo, Brazil. 2. Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: michael.farkouh@uhn.ca. 3. Heart Institute of the University of São Paulo Medical School, São Paulo, Brazil. 4. Department of Medicine, Mount Sinai Medical Center, New York, New York. 5. New England Research Institutes, Watertown, Massachusetts. 6. Heart Institute of the University of São Paulo Medical School, São Paulo, Brazil; Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada. 7. Division of Cardiology, Loyola University Stritch School of Medicine, Maywood, Illinois. 8. Department of Cardiology, University of New South Wales, Liverpool Hospital, Sydney, New South Wales, Australia. 9. Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
Abstract
BACKGROUND:Diabetes mellitus (DM) is associated with complex coronary artery disease (CAD), which in turn results in increased morbidity and mortality from cardiovascular disease. OBJECTIVES: This study sought to evaluate the utility of SYNTAX score (SS) for predicting future cardiovascular events in patients with DM and complex CAD undergoing either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). METHODS: The FREEDOM (Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease) trial randomized patients with DM and multivessel CAD to undergo either PCI with drug-eluting stents or CABG. The SS was calculated retrospectively by a core laboratory. The endpoint of hard cardiovascular events (HCE) was a composite of death from any cause, nonfatal myocardial infarction, and nonfatal stroke, while the endpoint of major adverse cardiac and cerebrovascular events (MACCE) was a composite of HCE and repeat revascularization. RESULTS: A total of 1,900 patients were randomized to PCI (n = 953) or CABG (n = 947). The SS was considered an independent predictor of 5-year MACCE (hazard ratio per unit of SS: 1.02; 95% confidence interval: 1.00 to 1.03; p = 0.014) and HCE (hazard ratio per unit of SS: 1.03; 95% confidence interval: 1.01 to 1.04; p = 0.002) in the PCI cohort, but not in the CABG group. There was a higher incidence of MACCE in PCI patients with low, intermediate, and high SS compared with those who underwent CABG (36.6% vs. 25.9%, p = 0.02; 43.9% vs. 26.8%, p < 0.001; 48.7% vs. 29.7%, p = 0.003, respectively). CONCLUSIONS: In DM patients with multivessel CAD, the complexity of CAD evaluated by the SS is an independent risk factor for MACCE and HCE only in patients undergoing PCI. The SS should not be utilized to guide the choice of coronary revascularization in patients with DM and multivessel CAD. (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450).
RCT Entities:
BACKGROUND:Diabetes mellitus (DM) is associated with complex coronary artery disease (CAD), which in turn results in increased morbidity and mortality from cardiovascular disease. OBJECTIVES: This study sought to evaluate the utility of SYNTAX score (SS) for predicting future cardiovascular events in patients with DM and complex CAD undergoing either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). METHODS: The FREEDOM (Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease) trial randomized patients with DM and multivessel CAD to undergo either PCI with drug-eluting stents or CABG. The SS was calculated retrospectively by a core laboratory. The endpoint of hard cardiovascular events (HCE) was a composite of death from any cause, nonfatal myocardial infarction, and nonfatal stroke, while the endpoint of major adverse cardiac and cerebrovascular events (MACCE) was a composite of HCE and repeat revascularization. RESULTS: A total of 1,900 patients were randomized to PCI (n = 953) or CABG (n = 947). The SS was considered an independent predictor of 5-year MACCE (hazard ratio per unit of SS: 1.02; 95% confidence interval: 1.00 to 1.03; p = 0.014) and HCE (hazard ratio per unit of SS: 1.03; 95% confidence interval: 1.01 to 1.04; p = 0.002) in the PCI cohort, but not in the CABG group. There was a higher incidence of MACCE in PCI patients with low, intermediate, and high SS compared with those who underwent CABG (36.6% vs. 25.9%, p = 0.02; 43.9% vs. 26.8%, p < 0.001; 48.7% vs. 29.7%, p = 0.003, respectively). CONCLUSIONS: In DMpatients with multivessel CAD, the complexity of CAD evaluated by the SS is an independent risk factor for MACCE and HCE only in patients undergoing PCI. The SS should not be utilized to guide the choice of coronary revascularization in patients with DM and multivessel CAD. (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450).
Authors: Rutao Wang; Patrick W Serruys; Chao Gao; Hironori Hara; Kuniaki Takahashi; Masafumi Ono; Hideyuki Kawashima; Neil O'leary; David R Holmes; Adam Witkowski; Nick Curzen; Francesco Burzotta; Stefan James; Robert-Jan van Geuns; Arie Pieter Kappetein; Marie-Angele Morel; Stuart J Head; Daniel J F M Thuijs; Piroze M Davierwala; Timothy O'Brien; Valentin Fuster; Scot Garg; Yoshinobu Onuma Journal: Eur Heart J Date: 2021-12-28 Impact factor: 29.983
Authors: Efstratios Karagiannidis; Dimitrios V Moysidis; Andreas S Papazoglou; Eleftherios Panteris; Olga Deda; Nikolaos Stalikas; Georgios Sofidis; Anastasios Kartas; Alexandra Bekiaridou; George Giannakoulas; Helen Gika; George Theodoridis; Georgios Sianos Journal: Cardiovasc Diabetol Date: 2022-05-07 Impact factor: 9.951