Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with <i>de</i> <i>novo</i> three vessel disease: 1-year results of the SYNTAX II study



Escaned, Javier, Collet, Carlos, Ryan, Nicola, De Maria, Giovanni Luigi, Walsh, Simon, Sabate, Manel, Davies, Justin, Lesiak, Maciej, Moreno, Raul, Cruz-Gonzalez, Ignacio
et al (show 28 more authors) (2017) Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with <i>de</i> <i>novo</i> three vessel disease: 1-year results of the SYNTAX II study. EUROPEAN HEART JOURNAL, 38 (42). pp. 3124-3134.

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Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study.pdf - Published version

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Abstract

<h4>Aims</h4>To investigate if recent technical and procedural developments in percutaneous coronary intervention (PCI) significantly influence outcomes in appropriately selected patients with three-vessel (3VD) coronary artery disease.<h4>Methods and results</h4>The SYNTAX II study is a multicenter, all-comers, open-label, single arm study that investigated the impact of a contemporary PCI strategy on clinical outcomes in patients with 3VD in 22 centres from four European countries. The SYNTAX-II strategy includes: heart team decision-making utilizing the SYNTAX Score II (a clinical tool combining anatomical and clinical factors), coronary physiology guided revascularisation, implantation of thin strut bioresorbable-polymer drug-eluting stents, intravascular ultrasound (IVUS) guided stent implantation, contemporary chronic total occlusion revascularisation techniques and guideline-directed medical therapy. The rate of major adverse cardiac and cerebrovascular events (MACCE [composite of all-cause death, cerebrovascular event, any myocardial infarction and any revascularisation]) at one year was compared to a predefined PCI cohort from the original SYNTAX-I trial selected on the basis of equipoise 4-year mortality between CABG and PCI. As an exploratory endpoint, comparisons were made with the historical CABG cohort of the original SYNTAX-I trial. Overall 708 patients were screened and discussed within the heart team; 454 patients were deemed appropriate to undergo PCI. At one year, the SYNTAX-II strategy was superior to the equipoise-derived SYNTAX-I PCI cohort (MACCE SYNTAX-II 10.6% vs. SYNTAX-I 17.4%; HR 0.58, 95% CI 0.39-0.85, P = 0.006). This difference was driven by a significant reduction in the incidence of MI (HR 0.27, 95% CI 0.11-0.70, P = 0.007) and revascularisation (HR 0.57, 95% CI 0.37-0.9, P = 0.015). Rates of all-cause death (HR 0.69, 95% CI 0.27-1.73, P = 0.43) and stroke (HR 0.69, 95% CI 0.10-4.89, P = 0.71) were similar. The rate of definite stent thrombosis was significantly lower in SYNTAX-II (HR 0.26, 95% CI 0.07-0.97, P = 0.045).<h4>Conclusion</h4>At one year, clinical outcomes with the SYNTAX-II strategy were associated with improved clinical results compared to the PCI performed in comparable patients from the original SYNTAX-I trial. Longer term follow-up is awaited and a randomized clinical trial with contemporary CABG is warranted.<h4>Clinicaltrials.gov identifier</h4>NCT02015832.

Item Type: Article
Uncontrolled Keywords: PCI, Drug-eluting stents, Multivessel disease, Coronary artery bypass graft
Depositing User: Symplectic Admin
Date Deposited: 13 May 2019 10:36
Last Modified: 11 Oct 2023 20:12
DOI: 10.1093/eurheartj/ehx512
Open Access URL: https://doi.org/10.1093/eurheartj/ehx512
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3041048