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Serruys PW, Kageyama S, Pompilio G, Andreini D, Pontone G, Mushtaq S, La Meir M, De Mey J, Tanaka K, Doenst T, Teichgräber U, Schneider U, Puskas JD, Narula J, Gupta H, Agarwal V, Leipsic J, Masuda S, Kotoku N, Tsai TY, Garg S, Morel MA, Onuma Y. Coronary bypass surgery guided by computed tomography in a low-risk population. Eur Heart J 2024; 45:1804-1815. [PMID: 38583086 PMCID: PMC11129794 DOI: 10.1093/eurheartj/ehae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/22/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND AND AIMS In patients with three-vessel disease and/or left main disease, selecting revascularization strategy based on coronary computed tomography angiography (CCTA) has a high level of virtual agreement with treatment decisions based on invasive coronary angiography (ICA). METHODS In this study, coronary artery bypass grafting (CABG) procedures were planned based on CCTA without knowledge of ICA. The CABG strategy was recommended by a central core laboratory assessing the anatomy and functionality of the coronary circulation. The primary feasibility endpoint was the percentage of operations performed without access to the ICA. The primary safety endpoint was graft patency on 30-day follow-up CCTA. Secondary endpoints included topographical adequacy of grafting, major adverse cardiac and cerebrovascular (MACCE), and major bleeding events at 30 days. The study was considered positive if the lower boundary of confidence intervals (CI) for feasibility was ≥75% (NCT04142021). RESULTS The study enrolled 114 patients with a mean (standard deviation) anatomical SYNTAX score and Society of Thoracic Surgery score of 43.6 (15.3) and 0.81 (0.63), respectively. Unblinding ICA was required in one case yielding a feasibility of 99.1% (95% CI 95.2%-100%). The concordance and agreement in revascularization planning between the ICA- and CCTA-Heart Teams was 82.9% with a moderate kappa of 0.58 (95% CI 0.50-0.66) and between the CCTA-Heart Team and actual treatment was 83.7% with a substantial kappa of 0.61 (95% CI 0.53-0.68). The 30-day follow-up CCTA in 102 patients (91.9%) showed an anastomosis patency rate of 92.6%, whilst MACCE was 7.2% and major bleeding 2.7%. CONCLUSIONS CABG guided by CCTA is feasible and has an acceptable safety profile in a selected population of complex coronary artery disease.
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Affiliation(s)
- Patrick W Serruys
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Shigetaka Kageyama
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Giulio Pompilio
- Centro Cardiologico Monzino, IRCCS, Monzino, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant’Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
| | | | | | - Mark La Meir
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, University Hospital Brussels, Brussels, Belgium
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
| | - Ulf Teichgräber
- Department of Radiology, University Hospital Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY, USA
| | - Jagat Narula
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Himanshu Gupta
- Department of Radiology, The Valley Hospital, Ridgewood, NJ, USA
| | - Vikram Agarwal
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY, USA
| | - Jonathon Leipsic
- St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Shinichiro Masuda
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Nozomi Kotoku
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Tsung-Ying Tsai
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Marie-Angele Morel
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Yoshinobu Onuma
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
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Chen Q, Xiong S, Ye T, Gao Y, Wang J, Li X, Li Y, Cui C, Liu H, Zhang Z, Cai L, Zheng J. Insulin resistance, coronary artery lesion complexity and adverse cardiovascular outcomes in patients with acute coronary syndrome. Cardiovasc Diabetol 2024; 23:172. [PMID: 38755609 PMCID: PMC11100181 DOI: 10.1186/s12933-024-02276-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/12/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Insulin resistance (IR) is linked to both the complexity of coronary artery lesions and the prognosis of acute coronary syndrome (ACS). However, the precise extent of this correlation and its impact on adverse cardiovascular outcomes in ACS patients remain unclear. Therefore, this study aims to investigate the intricate relationship between IR, coronary artery lesion complexity, and the prognosis of ACS through a cohort design analysis. METHOD A total of 986 patients with ACS who underwent percutaneous coronary intervention (PCI) were included in this analysis. IR was assessed using the triglyceride-glucose (TyG) index, while coronary artery lesion complexity was evaluated using the SYNTAX score. Pearson's correlation coefficients were utilized to analyze the correlations between variables. The association of the TyG index and SYNTAX score with major adverse cardiovascular events (MACEs) in ACS was investigated using the Kaplan-Meier method, restricted cubic splines (RCS), and adjusted Cox regression. Additionally, a novel 2-stage regression method for survival data was employed in mediation analysis to explore the mediating impact of the SYNTAX score on the association between the TyG index and adverse cardiovascular outcomes, including MACEs and unplanned revascularization. RESULTS During a median follow-up of 30.72 months, 167 cases of MACEs were documented, including 66 all-cause deaths (6.69%), 26 nonfatal myocardial infarctions (MIs) (2.64%), and 99 unplanned revascularizations (10.04%). The incidence of MACEs, all-cause death, and unplanned revascularization increased with elevated TyG index and SYNTAX score. Both the TyG index (non-linear, P = 0.119) and SYNTAX score (non-linear, P = 0.004) displayed a positive dose-response relationship with MACEs, as illustrated by the RCS curve. Following adjustment for multiple factors, both the TyG index and SYNTAX score emerged as significant predictors of MACEs across the total population and various subgroups. Mediation analysis indicated that the SYNTAX score mediated 25.03%, 18.00%, 14.93%, and 11.53% of the correlation between the TyG index and MACEs in different adjusted models, respectively. Similar mediating effects were observed when endpoint was defined as unplanned revascularization. CONCLUSION Elevated baseline TyG index and SYNTAX score were associated with a higher risk of MACEs in ACS. Furthermore, the SYNTAX score partially mediated the relationship between the TyG index and adverse cardiovascular outcomes.
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Affiliation(s)
- Qiang Chen
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Shiqiang Xiong
- Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Tao Ye
- Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Yanxiang Gao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Jian Wang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Xingliang Li
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yike Li
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Caiyan Cui
- Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Hanxiong Liu
- Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Zhen Zhang
- Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Lin Cai
- Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China.
| | - Jingang Zheng
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China.
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Aleksandric S, Beleslin B. Editorial comment: SYNTAX score II 2020 as a tool for decision making on revascularization strategy in high-risk patients with complex coronary artery disease. Catheter Cardiovasc Interv 2024; 103:680-681. [PMID: 38374776 DOI: 10.1002/ccd.30974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/04/2024] [Indexed: 02/21/2024]
Abstract
Key points
SYNTAX Score II 2020 outperforms both the anatomical SYNTAX Score and SYNTAX Score II in terms of predicting all‐cause mortality during long‐term follow‐up among patients with complex coronary artery disease (left main coronary artery disease, three‐vessel disease, or both) and chronic renal insufficiency undergoing percutaneous coronary intervention.
A predicted all‐cause mortality of the SYNTAX Score II 2020 >7% significantly adversely affected the observed all‐cause mortality in patients with complex coronary artery disease and chronic renal insufficiency undergoing percutaneous coronary intervention.
For prospective validation of the SYNTAX score II 2020 model in patients with complex coronary artery disease, particularly those with moderate‐to‐severe chronic renal insufficiency (eGFR <60 mL/min/1.73m2), further adequately powered, randomized trials of percutaneous coronary intervention versus coronary artery bypass graft surgery must be conducted, with long‐term follow‐up.
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Affiliation(s)
- Srdjan Aleksandric
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Li M, Liu X, Jiang M, Lei Y, Liu W, Li Z, Li S, Liu R, Cao X, Yan L. External validation of the SYNTAX score II 2020 in patients with chronic renal insufficiency. Catheter Cardiovasc Interv 2024; 103:391-403. [PMID: 38204355 DOI: 10.1002/ccd.30952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/05/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The SYNTAX score Ⅱ 2020 (SSⅡ-2020) was created as a customized decision-making tool for individuals diagnosed with complex coronary artery disease (CAD). Nevertheless, there has been a scarcity of research investigating the long-term predictive significance of SSⅡ-2020 for patients with both CAD and chronic renal insufficiency (CRI) who undergo percutaneous coronary intervention (PCI). AIMS We sought to showcase the prognostic capacity of SSII-2020 in evaluating long-term all-cause mortality (ACM) within this high-risk patient cohort. METHODS A retrospective cohort comprising 1156 individuals diagnosed with CRI and exhibiting left main CAD, three-vessel CAD or both was included in this investigation. We categorized participants into three groups based on the optimal SSII-2020 threshold for predicting long-term ACM, determined using the X-tile software. RESULTS At the median follow-up duration of 6.3 years, the ACM rates were determined to be 10% in the low, 17% in the moderate, and 28% in the high SSII-2020 groups (p < 0.001). Employing multivariate Cox regression analysis, it was observed that the high SSII-2020 group exhibited a 3.289-fold increased risk of ACM (95% confidence interval [CI]: 2.229-4.856, p < 0.001) compared with the low SSII-2020 group, whereas the high SSII-2020 group displayed a 1.757-fold (95% CI: 1.190-2.597, p = 0.005) in comparison to the median SSII-2020 groups. Compared with SSII, the SSII-2020 had an incremental value for predicting 7-year ACM (C-index: 0.662 vs. 0.534, p = 0.007; IDI: 0.016, p < 0.001). CONCLUSIONS SSII-2020 enhances long-term ACM prediction, facilitates improved risk stratification, and improves clinical utility for PCI patients with complex CAD and CRI.
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Affiliation(s)
- Mengyao Li
- Department of Cardiology, Dongguan Cardiovascular Research Institute, Dongguan Songshan Lake Central Hospital, Guangdong Medical University, Dongguan, China
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, China
| | - Xu Liu
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, China
| | - Mao Jiang
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, China
| | - Yumeng Lei
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, China
| | - Wenjie Liu
- Department of Cardiology, Dongguan Cardiovascular Research Institute, Dongguan Songshan Lake Central Hospital, Guangdong Medical University, Dongguan, China
| | - Zhongpei Li
- Department of Cardiology, Dongguan Cardiovascular Research Institute, Dongguan Songshan Lake Central Hospital, Guangdong Medical University, Dongguan, China
| | - Shicheng Li
- Department of Cardiology, Dongguan Cardiovascular Research Institute, Dongguan Songshan Lake Central Hospital, Guangdong Medical University, Dongguan, China
| | - Ruijie Liu
- Department of Cardiology, Dongguan Cardiovascular Research Institute, Dongguan Songshan Lake Central Hospital, Guangdong Medical University, Dongguan, China
| | - Xufen Cao
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, China
| | - Liqiu Yan
- Department of Cardiology, Dongguan Cardiovascular Research Institute, Dongguan Songshan Lake Central Hospital, Guangdong Medical University, Dongguan, China
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, China
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Sung WT, Chuang MJ, Tsai YL, Chou RH, Chang CC, Huang PH. Impacts of the SYNTAX score I, II and SYNTAX score II 2020 on left main revascularization. Sci Rep 2024; 14:1073. [PMID: 38212627 PMCID: PMC10784526 DOI: 10.1038/s41598-024-51192-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/01/2024] [Indexed: 01/13/2024] Open
Abstract
Patients with left main coronary artery disease (LMCAD) with a high SYNTAX score (SS) were excluded from randomized studies that comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). We sought to compare PCI and CABG in the real-world practice and investigate the impact of SS I, SS II, and SS II 2020 on clinical outcomes. In total, 292 Patients with LMCAD (173 PCI, 119 CABG) treated between 2017 and 2021 were enrolled. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, stroke, or myocardial infarction (MI). The mean SS I was high in both groups (PCI vs. CABG: 31.64 ± 11.45 vs. 32.62 ± 11.75, p = 0.660). The primary outcome occurred in 28 patients (16.2%) in the PCI group and in 19 patients (16.0%) in the CABG group without significant difference [adjusted hazard ratio, 95% CI = 0.98 (0.51-1.90), p = 0.97] over the follow-up period (26.9 ± 17.7 months). No significant difference was observed in all-cause mortality (11.6% vs. 11.8%, p = 0.93) or stroke rates (3.5% vs. 5.0%, p = 0.51) between groups. However, PCI was associated with higher MI (4.6% vs. 0.8%, p < 0.05) and revascularization rates (26% vs. 5.9%, p < 0.001). Prognostic value of the SS I, SS II and SS II 2020 on the primary outcome was not relevant in the PCI group. Among patients with LMCAD, PCI and CABG did not significantly differ in the composite endpoint of all-cause death, stroke, and MI. These results support the potential expansion of PCI indications in LMCAD management for whom are ineligible for CABG with complex coronary artery disease.
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Affiliation(s)
- Wei-Ting Sung
- Division of Cardiology, Department of Medicine, Taipei Veteran General Hospital, 112, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Ju Chuang
- Division of Cardiology, Department of Medicine, Taipei Veteran General Hospital, 112, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Lin Tsai
- Division of Cardiology, Department of Medicine, Taipei Veteran General Hospital, 112, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ruey-Hsing Chou
- Division of Cardiology, Department of Medicine, Taipei Veteran General Hospital, 112, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Chin Chang
- Division of Cardiology, Department of Medicine, Taipei Veteran General Hospital, 112, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veteran General Hospital, 112, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Lim K, Wan S. Commentary: Looking into the crystal ball: Will a clinical SYNTAX score help the heart team? J Thorac Cardiovasc Surg 2024; 167:174-175. [PMID: 35321799 DOI: 10.1016/j.jtcvs.2022.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Kevin Lim
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Song Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
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Masuda S, Serruys PW, Ninomiya K, Kageyama S, Nozomi K, Gao C, Mack MJ, Holmes DR, Morice MC, Thuijs DJFM, Milojevic M, Davierwala PM, Garg S, Onuma Y. Impact of left ventricular ejection fraction on 10-year mortality in the SYNTAX trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:7-15. [PMID: 37414612 DOI: 10.1016/j.carrev.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUNDS The impact of reduced left ventricular ejection fraction (LVEF) on very long-term prognosis following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) has been debated. The aim of this study was to investigate the impact of LVEF at baseline on 10-year mortality in the SYNTAX trial. METHODS Patients (n = 1800) were categorized into three sub-groups: reduced (rEF ≤ 40 %), mildly reduced (mrEF 41-49 %), and preserved LVEF (pEF ≥ 50 %). The SYNTAX score 2020 (SS-2020) was applied in patients with LVEF<50 % and ≥ 50 %. RESULTS Ten-year mortalities were 44.0 %, 31.8 %, and 22.6 % (P < 0.001) in patients with rEF (n = 168), mrEF (n = 179), and pEF (n = 1453). Although no significant differences were observed, the mortality with PCI was higher than with CABG in patients with rEF (52.9 % vs 39.6 %, P = 0.054) and mrEF (36.0 % vs. 28.6 %, P = 0.273), and comparable in pEF (23.9 % vs. 22.2 %, P = 0.275). Calibration and discrimination of the SS-2020 in patients with LVEF<50 % were poor, whilst they were reasonable in those with LVEF≥50 %. The proportion of patients eligible for PCI who had a predicted equipoise in mortality with CABG was estimated to be 57.5 % in patients with LVEF≥50 %. CABG was safer than PCI in 62.2 % of patients with LVEF<50 %. CONCLUSIONS Reduced LVEF was associated with an increased risk of 10-year mortality in patients revascularized either surgically or percutaneously. Compared to PCI, CABG was safe revascularization in patients with LVEF≤40 %. In patients with LVEF≥50 % individualized 10-year all-cause mortality predicted by SS-2020 was helpful in decision-making whilst the predictivity in patients with LVEF<50 % was poor.
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Affiliation(s)
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| | - Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Kotoku Nozomi
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Xi'an, China; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marie-Claude Morice
- Département of Cardiologie, Hôpital privé Jacques Cartier, Générale de Santé Massy, France
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Piroze M Davierwala
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany; Department of Surgery, University of Toronto, Toronto, Canada; Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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Kurlansky PA, Bittl JA. Learning From Machines to Predict Mortality After Surgical or Percutaneous Revascularization. J Am Coll Cardiol 2023; 82:2125-2127. [PMID: 37993204 DOI: 10.1016/j.jacc.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Paul A Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Columbia University Irving Medical Center, New York, New York, USA.
| | - John A Bittl
- Scientific Publications Committee, American College of Cardiology, Washington, DC, USA
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Ninomiya K, Kageyama S, Shiomi H, Kotoku N, Masuda S, Revaiah PC, Garg S, O'Leary N, van Klaveren D, Kimura T, Onuma Y, Serruys PW. Can Machine Learning Aid the Selection of Percutaneous vs Surgical Revascularization? J Am Coll Cardiol 2023; 82:2113-2124. [PMID: 37993203 DOI: 10.1016/j.jacc.2023.09.818] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND In patients with 3-vessel coronary artery disease (CAD) and/or left main CAD, individual risk prediction plays a key role in deciding between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). OBJECTIVES The aim of this study was to assess whether these individualized revascularization decisions can be improved by applying machine learning (ML) algorithms and integrating clinical, biological, and anatomical factors. METHODS In the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) study, ML algorithms (Lasso regression, gradient boosting) were used to develop a prognostic index for 5-year death, which was combined, in the second stage, with assigned treatment (PCI or CABG) and prespecified effect-modifiers: disease type (3-vessel or left main CAD) and anatomical SYNTAX score. The model's discriminative ability to predict the risk of 5-year death and treatment benefit between PCI and CABG was cross-validated in the SYNTAX trial (n = 1,800) and externally validated in the CREDO-Kyoto (Coronary REvascularization Demonstrating Outcome Study in Kyoto) registry (n = 7,362), and then compared with the original SYNTAX score II 2020 (SSII-2020). RESULTS The hybrid gradient boosting model performed best for predicting 5-year all-cause death with C-indexes of 0.78 (95% CI: 0.75-0.81) in cross-validation and 0.77 (95% CI: 0.76-0.79) in external validation. The ML models discriminated 5-year mortality better than the SSII-2020 in the external validation cohort and identified heterogeneity in the treatment benefit of CABG vs PCI. CONCLUSIONS An ML-based approach for identifying individuals who benefit from CABG or PCI is feasible and effective. Implementation of this model in health care systems-trained to collect large numbers of parameters-may harmonize decision making globally. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries; NCT00114972).
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Affiliation(s)
- Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | | | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Neil O'Leary
- Department of Cardiology, University of Galway, Galway, Ireland
| | - David van Klaveren
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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10
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Byrne RA, Fremes S, Capodanno D, Czerny M, Doenst T, Emberson JR, Falk V, Gaudino M, McMurray JJV, Mehran R, Milojevic M, Sousa Uva M. 2022 Joint ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease in patients at low surgical risk and anatomy suitable for PCI or CABG. Eur Heart J 2023; 44:4310-4320. [PMID: 37632756 DOI: 10.1093/eurheartj/ehad476] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/06/2023] [Accepted: 07/15/2023] [Indexed: 08/28/2023] Open
Abstract
In October 2021, the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) jointly agreed to establish a Task Force (TF) to review recommendations of the 2018 ESC/EACTS Guidelines on myocardial revascularization as they apply to patients with left main (LM) disease with low-to-intermediate SYNTAX score (0-32). This followed the withdrawal of support by the EACTS in 2019 for the recommendations about the management of LM disease of the previous guideline. The TF was asked to review all new relevant data since the 2018 guidelines including updated aggregated data from the four randomized trials comparing percutaneous coronary intervention (PCI) with drug-eluting stents vs. coronary artery bypass grafting (CABG) in patients with LM disease. This document represents a summary of the work of the TF; suggested updated recommendations for the choice of revascularization modality in patients undergoing myocardial revascularization for LM disease are included. In stable patients with an indication for revascularization for LM disease, with coronary anatomy suitable for both procedures and a low predicted surgical mortality, the TF concludes that both treatment options are clinically reasonable based on patient preference, available expertise, and local operator volumes. The suggested recommendations for revascularization with CABG are Class I, Level of Evidence A. The recommendations for PCI are Class IIa, Level of Evidence A. The TF recognized several important gaps in knowledge related to revascularization in patients with LM disease and recognizes that aggregated data from the four randomized trials were still only large enough to exclude large differences in mortality.
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Affiliation(s)
- Robert A Byrne
- Department of Cardiology and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, 73 Eccles St, Dublin D07 KWR1, Ireland
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, D02 YN77 Dublin, Ireland
| | - Stephen Fremes
- Division of Cardiac Surgery, Schulich Heart Program, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Suite H405, M4N3M5 Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Davide Capodanno
- Cardio-Thoracic-Vascular and Transplant Department, Azienda Ospedaliero-Universitaria Policlinico 'Gaspare Rodolico-San Marco', University of Catania, Catania, Italy
| | - Martin Czerny
- Clinic for Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
- Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Jonathan R Emberson
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, DZHK, Partner Site Berlin, Berlin, Germany
- Department of Health Science and Technology, ETH Zurich, Zürich, Switzerland
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Miguel Sousa Uva
- Department of Cardiac Surgery, Hospital Santa Cruz, Carnaxide, Portugal
- Department of Physiology and Cardiac Surgery, Porto University Medical School, Porto, Portugal
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11
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Mézquita AJV, Biavati F, Falk V, Alkadhi H, Hajhosseiny R, Maurovich-Horvat P, Manka R, Kozerke S, Stuber M, Derlin T, Channon KM, Išgum I, Coenen A, Foellmer B, Dey D, Volleberg RHJA, Meinel FG, Dweck MR, Piek JJ, van de Hoef T, Landmesser U, Guagliumi G, Giannopoulos AA, Botnar RM, Khamis R, Williams MC, Newby DE, Dewey M. Clinical quantitative coronary artery stenosis and coronary atherosclerosis imaging: a Consensus Statement from the Quantitative Cardiovascular Imaging Study Group. Nat Rev Cardiol 2023; 20:696-714. [PMID: 37277608 DOI: 10.1038/s41569-023-00880-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/07/2023]
Abstract
The detection and characterization of coronary artery stenosis and atherosclerosis using imaging tools are key for clinical decision-making in patients with known or suspected coronary artery disease. In this regard, imaging-based quantification can be improved by choosing the most appropriate imaging modality for diagnosis, treatment and procedural planning. In this Consensus Statement, we provide clinical consensus recommendations on the optimal use of different imaging techniques in various patient populations and describe the advances in imaging technology. Clinical consensus recommendations on the appropriateness of each imaging technique for direct coronary artery visualization were derived through a three-step, real-time Delphi process that took place before, during and after the Second International Quantitative Cardiovascular Imaging Meeting in September 2022. According to the Delphi survey answers, CT is the method of choice to rule out obstructive stenosis in patients with an intermediate pre-test probability of coronary artery disease and enables quantitative assessment of coronary plaque with respect to dimensions, composition, location and related risk of future cardiovascular events, whereas MRI facilitates the visualization of coronary plaque and can be used in experienced centres as a radiation-free, second-line option for non-invasive coronary angiography. PET has the greatest potential for quantifying inflammation in coronary plaque but SPECT currently has a limited role in clinical coronary artery stenosis and atherosclerosis imaging. Invasive coronary angiography is the reference standard for stenosis assessment but cannot characterize coronary plaques. Finally, intravascular ultrasonography and optical coherence tomography are the most important invasive imaging modalities for the identification of plaques at high risk of rupture. The recommendations made in this Consensus Statement will help clinicians to choose the most appropriate imaging modality on the basis of the specific clinical scenario, individual patient characteristics and the availability of each imaging modality.
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Affiliation(s)
| | - Federico Biavati
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site, Berlin, Germany
- Department of Health Science and Technology, ETH Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Reza Hajhosseiny
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Robert Manka
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Stuber
- Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Keith M Channon
- Radcliffe Department of Medicine, University of Oxford and Oxford University Hospitals, Oxford, UK
| | - Ivana Išgum
- Department of Biomedical Engineering and Physics, Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Adriaan Coenen
- Department of Radiology, Erasmus University, Rotterdam, Netherlands
| | - Bernhard Foellmer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Damini Dey
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rick H J A Volleberg
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Felix G Meinel
- Department of Radiology, University Medical Centre Rostock, Rostock, Germany
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology and Cardiovascular Sciences, Amsterdam UMC, Heart Center, University of Amsterdam, Amsterdam, Netherlands
| | - Tim van de Hoef
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ulf Landmesser
- DZHK (German Centre for Cardiovascular Research) Partner Site, Berlin, Germany
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Giulio Guagliumi
- Division of Cardiology, IRCCS Galeazzi Sant'Ambrogio Hospital, Milan, Italy
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile
| | - Ramzi Khamis
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research) Partner Site, Berlin, Germany.
- Deutsches Herzzentrum der Charité (DHZC), Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany.
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12
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Scala A, Erriquez A, Verardi FM, Marrone A, Scollo E, Trichilo M, Durante A, Tedeschi D, Cortese B, Ielasi A, Valentini G, Tebaldi M, Campo G, Pavasini R, Biscaglia S. Functional (Re)Development of SYNTAX Score II 2020: Predictive Performance and Risk Assessment. J Clin Med 2023; 12:5844. [PMID: 37762785 PMCID: PMC10531756 DOI: 10.3390/jcm12185844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The present study investigates the prognostic value of the Syntax Score II 2020 corrected for flow-limiting lesions and its ability to better address treatment by benefit prediction among patients with left main or multivessel disease. We analyzed 1274 patients from the HALE-BOPP cohort and integrated the Syntax Score II 2020 with the result of the fractional flow reserve (FFR) evaluation. Absolute risk difference (ARD) between surgical and percutaneous revascularization was calculated for anatomic and functional Syntax Score II 2020 predicted mortality. The ARD allowed to stratify the population into two large categories: "coronary artery bypass graft (CABG) better" with ARD ≥ 4.5% and "CABG-percutaneous coronary intervention (PCI) equipoise" with ARD < 4.5%. The mean global anatomical Syntax Score was 15.5 ± 9.2, whereas the functional one was 9.5 ± 10 (p < 0.01). Using the anatomic Syntax Score II 2020, 881 patients had a CABG-PCI equipoise. This number increased to 1041 after considering only flow-limiting lesions by FFR (p < 0.001); therefore, 40% of CABG better patients were reclassified within the CABG-PCI equipoise category. Kaplan-Maier curves showed similar actual survival rates for patients originally with CABG-PCI equipoise and those reclassified, in both cases higher than those from CABG better patients (p < 0.01). The integration between Syntax Score II 2020 and physiology is feasible, and merging clinical, anatomic and functional data allows for better risk prediction and therapeutic guidance.
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Affiliation(s)
- Antonella Scala
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (A.S.); (A.E.); (F.M.V.); (A.M.); (E.S.); (M.T.); (M.T.); (G.C.); (S.B.)
| | - Andrea Erriquez
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (A.S.); (A.E.); (F.M.V.); (A.M.); (E.S.); (M.T.); (M.T.); (G.C.); (S.B.)
| | - Filippo Maria Verardi
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (A.S.); (A.E.); (F.M.V.); (A.M.); (E.S.); (M.T.); (M.T.); (G.C.); (S.B.)
| | - Andrea Marrone
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (A.S.); (A.E.); (F.M.V.); (A.M.); (E.S.); (M.T.); (M.T.); (G.C.); (S.B.)
| | - Ennio Scollo
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (A.S.); (A.E.); (F.M.V.); (A.M.); (E.S.); (M.T.); (M.T.); (G.C.); (S.B.)
| | - Michele Trichilo
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (A.S.); (A.E.); (F.M.V.); (A.M.); (E.S.); (M.T.); (M.T.); (G.C.); (S.B.)
| | | | - Delio Tedeschi
- Cardiology Department, Istituto Clinico S. Anna, 25127 Brescia, Italy;
| | - Bernardo Cortese
- Cardiology Department, Clinica San Carlo, 20037 Paderno Dugnano, Italy;
| | - Alfonso Ielasi
- Cardiology Department, Istituto Clinico Sant’Ambrogio, 20161 Milano, Italy;
| | - Giuliano Valentini
- Cardiology Department, Ospedale San Filippo e Nicola, 67051 Avezzano, Italy;
| | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (A.S.); (A.E.); (F.M.V.); (A.M.); (E.S.); (M.T.); (M.T.); (G.C.); (S.B.)
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (A.S.); (A.E.); (F.M.V.); (A.M.); (E.S.); (M.T.); (M.T.); (G.C.); (S.B.)
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (A.S.); (A.E.); (F.M.V.); (A.M.); (E.S.); (M.T.); (M.T.); (G.C.); (S.B.)
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy; (A.S.); (A.E.); (F.M.V.); (A.M.); (E.S.); (M.T.); (M.T.); (G.C.); (S.B.)
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13
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Lazar HL. Commentary: Developing accurate tools for predicting outcomes following coronary artery bypass graft surgery: More data are needed. J Thorac Cardiovasc Surg 2023; 166:801-804. [PMID: 34998591 DOI: 10.1016/j.jtcvs.2021.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, Boston University School of Medicine, Boston, Mass.
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14
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Masuda S, Serruys PW, Kageyama S, Kotoku N, Ninomiya K, Garg S, Soo A, Morel MA, Puskas JD, Narula J, Schneider U, Doenst T, Tanaka K, de Mey J, La Meir M, Bartorelli AL, Mushtaq S, Pompilio G, Andreini D, Onuma Y. Treatment recommendation based on SYNTAX score 2020 derived from coronary computed tomography angiography and invasive coronary angiography. Int J Cardiovasc Imaging 2023; 39:1795-1804. [PMID: 37368152 PMCID: PMC10519866 DOI: 10.1007/s10554-023-02884-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023]
Abstract
The diagnostic performance of the SYNTAX score 2020 (SS-2020) when calculated using CCTA remains unknown. This study aimed to compare treatment recommendations based on the SS-2020 derived from coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA). This interim analysis included 57 of the planned 114 patients with de-novo three-vessel disease, with or without left main coronary artery disease, enrolled in the ongoing FASTTRACK CABG trial. The anatomical SYNTAX scores derived from ICA or CCTA were evaluated by two separate teams of blinded core-lab analysts. Treatment recommendations were based on a maximal individual absolute risk difference in all-cause mortality between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) of 4.5% ([predicted PCI mortality] - [predicted CABG mortality]). The level of agreement was evaluated with Bland-Altman plots and Cohen's Kappa. The mean age was 66.2 ± 9.2 years and 89.5% of patients were male. Mean anatomical SYNTAX scores derived from ICA and CCTA were 35.1 ± 11.5 and 35.6 ± 11.4 (p = 0.751), respectively. The Bland-Altman analysis showed mean differences of - 0.26 and - 0.93, with standard deviation of 3.69 and 5.23, for 5- and 10-year all-cause mortality, respectively. The concordance in recommended treatment for 5- and 10-year mortalities were 84.2% (48/57 patients) and 80.7% (46/57 patients), with Cohen's κ coefficients of 0.672 and 0.551. There was moderate to substantial agreement between treatment recommendations based on the SS-2020 derived using CCTA and ICA, suggesting that CCTA could be used as an alternative to ICA when making decisions regarding the modality of revascularization.
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Affiliation(s)
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, Galway, Ireland.
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | | | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Alan Soo
- Department of Cardiothoracic Surgery, University Hospital Galway, Galway, Ireland
| | | | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, USA
| | - Jagat Narula
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena University Hospital, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena University Hospital, Jena, Germany
| | - Kaoru Tanaka
- Department of Radiology, Vrije Universiteit Brussels, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Vrije Universiteit Brussels, Brussels, Belgium
| | - Mark La Meir
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Belgium, Belgium
| | - Antonio L Bartorelli
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Saima Mushtaq
- Department of Periooperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Giulio Pompilio
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Belgium, Belgium
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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15
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Masuda S, Serruys PW, Mushtaq S, Tanaka K, Mandry D, Buechel RR, Digne F, Schneider U, Pompilio G, La Meir M, Doenst T, Teichgraber U, Morel MA, Kotoku N, Ninomiya K, Kageyama S, O'Leary N, Collet C, Garg S, de Mey J, Andreini D, Onuma Y. The ability of computed tomography angiography to predict 5-year mortality in the SYNTAX III REVOLUTION trial. J Cardiovasc Comput Tomogr 2023; 17:318-325. [PMID: 37684158 DOI: 10.1016/j.jcct.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The feasibility of using coronary computed tomography angiography (CCTA) for long-term prediction of vital prognosis post-revascularization remains unknown. OBJECTIVES To compare the prognostic value of the SYNTAX score II 2020 (SS-2020) derived from invasive coronary angiography (ICA) or CCTA in patients with three-vessel disease and/or left main coronary artery disease undergoing percutaneous or surgical revascularization. METHODS In the SYNTAX III REVOLUTION trial, the probability of death at five years was retrospectively assessed by calculating the SS-2020 using ICA and CCTA. High- and low-risk patients for mortality were categorized according to the median percentages of predicted mortality based on both modalities. The discriminative abilities of the SS-2020 were assessed using Harrell's C statistic. RESULTS The vital status at five years of the 215 patients revascularized percutaneously (64 patients, 29.8%) or surgically (151 patients, 70.2%) was established through national registries. In patients undergoing revascularization, the SS-2020 was possibly helpful in discriminating vital prognosis at 5 years, with similar results seen with ICA and CCTA (C-index with ICA = 0.75, intercept = -0.19, slope = 0.92 and C-index with CCTA = 0.75, intercept = -0.22, slope = 0.99). In high- and low-risk patients, Kaplan-Meier estimates showed significant, and almost identical relative differences in observed mortality, irrespective of imaging modality (ICA: 93.8% vs 78.7%, log-lank P < 0.001; CCTA: 93.7% vs 78.5%, log-lank P < 0.001). CONCLUSIONS The predictive ability of the SS-2020 for five-year all-cause mortality derived from ICA and CCTA was comparable, and could helpfully discriminate vital prognosis in high- and low-risk patients.
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Affiliation(s)
| | | | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRRCS, Milan, Italy
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Damien Mandry
- Department of Radiology, CHRU Nancy and University of Lorraine, Nancy, France
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Franck Digne
- Hemodynamic Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital Jena, Jena, Germany
| | - Giulio Pompilio
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRRCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Mark La Meir
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital Jena, Jena, Germany
| | - Ulf Teichgraber
- Department of Radiology, Friedrich-Schiller-University Jena, University Hospital Jena, Jena, Germany
| | | | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Neil O'Leary
- Interventional Medicine and Innovation, University of Galway, Galway, Ireland
| | - Carlos Collet
- Onze Lieve Vrouwziekenhuis, Cardiovascular Center Aalst, Aalst, Belgium
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom; Department of Medical Education, University of Central Lancashire, Preston, United Kingdom
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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16
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Premsagar P, Aldous C, Esterhuizen T. Cardiac scoring systems, coronary artery disease and major adverse cardiovascular events: A scoping review. S Afr Fam Pract (2004) 2023; 65:e1-e8. [PMID: 37782230 PMCID: PMC10476223 DOI: 10.4102/safp.v65i1.5683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND In 2019, the World Health Organization (WHO) declared coronary artery disease (CAD) as the leading cause of death globally for the last 20 years. Early screening and detection (primary prevention) and intervention (secondary prevention) are necessary to curb CAD and major adverse cardiovascular event (MACE) prevalence. A scoping review to assess the current literature on using cardiac scoring systems to predict CAD and MACE was performed. METHODS The research question 'What is the literature on using cardiac scoring systems to predict CAD and MACE?' was addressed. The updated Arksey and O'Malley and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews methodologies were used. The search terms 'coronary artery disease' and 'cardiac scoring systems' and 'major adverse cardiovascular events' were used in the Boolean search on PubMed, ScienceDirect, MedLine and Cochrane Library. RESULTS The final list consisted of 19 published English results after the year 2000. There were six results without participants (four clinical guidelines, one review article and one ongoing clinical trial). Scoring systems were cardiovascular risk estimation systems focusing on the primary prevention of CAD; MACE was discussed but not scored. There were 13 robust results published from completed multinational clinical trials with participants. These results focused on a scoring system for the secondary prevention of CAD and MACE. CONCLUSION Scoring systems remain an objective method for primary and secondary prevention of CAD and MACE.Contribution: Scoring systems may be helpful with clinical uncertainty or to standardise patient results for comparison in research.
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Affiliation(s)
- Preesha Premsagar
- Department of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban.
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Kageyama S, Serruys PW, Ninomiya K, O’Leary N, Masuda S, Kotoku N, Colombo A, van Geuns RJ, Milojevic M, Mack MJ, Soo A, Garg S, Onuma Y, Davierwala PM. Impact of on-pump and off-pump coronary artery bypass grafting on 10-year mortality versus percutaneous coronary intervention. Eur J Cardiothorac Surg 2023; 64:ezad240. [PMID: 37348857 PMCID: PMC10693439 DOI: 10.1093/ejcts/ezad240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES The very long-term mortality of off-pump and on-pump coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in a randomized complex coronary artery disease population is unknown. This study aims to investigate the impact of on-pump and off-pump CABG versus PCI on 10-year all-cause mortality. METHODS The SYNTAX trial randomized 1800 patients with three-vessel and/or left main coronary artery disease to PCI or CABG and assessed their survival at 10 years. In this sub-study, the hazard of mortality over 10 years was compared according to the technique of revascularization: on-pump CABG (n = 725), off-pump CABG (n = 128) and PCI (n = 903). RESULTS There was substantial inter-site variation in the use of off-pump CABG despite baseline characteristics being largely homogeneous among the 3 groups. The crude rate of mortality was significantly lower following on-pump CABG versus PCI [25.6% vs 28.4%, hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.65-0.96], while it was comparable between off-pump CABG and PCI (28.5% vs 28.4%, HR 0.98, 95% CI 0.69-1.40). After adjusting for the 9 variables included in the SYNTAX score II 2020, 10-year mortality remained significantly lower with on-pump CABG than PCI (HR 0.75 against PCI, P = 0.009). CONCLUSIONS In the SYNTAXES trial, 10-year mortality adjusted for major confounders was significantly lower following on-pump CABG compared to PCI. There was no evidence for unadjusted difference between off-pump CABG and PCI, although the unadjusted estimated HR had a wide CI. Site heterogeneity in the technique used in bypass surgery has had measurable effects on treatment performance.
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Affiliation(s)
- Shigetaka Kageyama
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Kai Ninomiya
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Neil O’Leary
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Nozomi Kotoku
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Humanitas Clinical and Research Centre IRCCS, Milan, Italy
| | - Robert-Jan van Geuns
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Alan Soo
- Department of Cardiothoracic Surgery, University Hospital Galway, Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Piroze M Davierwala
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
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Byrne RA, Fremes S, Capodanno D, Czerny M, Doenst T, Emberson JR, Falk V, Gaudino M, McMurray JJV, Mehran R, Milojevic M, Uva MS. 2022 Joint ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease in patients at low surgical risk and anatomy suitable for PCI or CABG. Eur J Cardiothorac Surg 2023; 64:ezad286. [PMID: 37632766 DOI: 10.1093/ejcts/ezad286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/06/2023] [Accepted: 07/15/2023] [Indexed: 08/28/2023] Open
Abstract
Task Force structure and summary of clinical evidence of 2022 ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease. CABG, coronary artery bypass grafting; PCI, percutaneous coronary intervention; LM, left main; SYNTAX, Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery. a'Event' refers to the composite of death, myocardial infarction (according to Universal Definition of Myocardial Infarction if available, otherwise protocol defined) or stroke. In October 2021, the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) jointly agreed to establish a Task Force (TF) to review recommendations of the 2018 ESC/EACTS Guidelines on myocardial revascularization as they apply to patients with left main (LM) disease with low-to-intermediate SYNTAX score (0-32). This followed the withdrawal of support by the EACTS in 2019 for the recommendations about the management of LM disease of the previous guideline. The TF was asked to review all new relevant data since the 2018 guidelines including updated aggregated data from the four randomized trials comparing percutaneous coronary intervention (PCI) with drug-eluting stents vs. coronary artery bypass grafting (CABG) in patients with LM disease. This document represents a summary of the work of the TF; suggested updated recommendations for the choice of revascularization modality in patients undergoing myocardial revascularization for LM disease are included. In stable patients with an indication for revascularization for LM disease, with coronary anatomy suitable for both procedures and a low predicted surgical mortality, the TF concludes that both treatment options are clinically reasonable based on patient preference, available expertise, and local operator volumes. The suggested recommendations for revascularization with CABG are Class I, Level of Evidence A. The recommendations for PCI are Class IIa, Level of Evidence A. The TF recognized several important gaps in knowledge related to revascularization in patients with LM disease and recognizes that aggregated data from the four randomized trials were still only large enough to exclude large differences in mortality.
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Affiliation(s)
- Robert A Byrne
- Department of Cardiology and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, 73 Eccles St, Dublin D07 KWR1, Ireland
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin D02 YN77, Ireland
| | - Stephen Fremes
- Division of Cardiac Surgery, Schulich Heart Program, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Suite H405, M4N3M5 Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Davide Capodanno
- Cardio-Thoracic-Vascular and Transplant Department, Azienda Ospedaliero-Universitaria Policlinico 'Gaspare Rodolico-San Marco', University of Catania, Catania, Italy
| | - Martin Czerny
- Clinic for Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
- Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Jonathan R Emberson
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, DZHK, Partner Site Berlin, Berlin, Germany
- Department of Health Science and Technology, ETH Zurich, Zürich, Switzerland
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Miguel Sousa Uva
- Department of Cardiac Surgery, Hospital Santa Cruz, Carnaxide, Portugal
- Department of Physiology and Cardiac Surgery, Porto University Medical School, Porto, Portugal
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Serruys PW, Revaiah PC, Ninomiya K, Masuda S, Kotoku N, Kageyama S, Onuma Y, Morel MA, Garg S, Feldman T, Kappetein AP, Holmes DR, Mack MJ, Mohr FW. 10 Years of SYNTAX: Closing an Era of Clinical Research After Identifying New Outcome Determinants. JACC. ASIA 2023; 3:409-430. [PMID: 37396431 PMCID: PMC10308124 DOI: 10.1016/j.jacasi.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/21/2023] [Accepted: 03/24/2023] [Indexed: 07/04/2023]
Abstract
The SYNTAX trial randomized patients equally eligible for coronary artery bypass grafting or percutaneous coronary intervention using the Heart Team approach. The SYNTAXES study achieved a follow-up rate of 93.8% and reported the 10-year vital status. Factors associated with increased mortality at 10 years were pharmacologically treated diabetes mellitus, increased waist circumference, reduced left ventricular function, prior cerebrovascular and peripheral vascular disease, western Europe and North American descent, current smoking, chronic obstructive pulmonary disease, elevated C-reactive protein, anemia, and an increase in HbA1c. Procedural factors associated with higher 10 years mortality include periprocedural myocardial infarction, extensive stenting, small stents, ≥1 heavily calcified lesion, ≥1 bifurcation lesion, residual SYNTAX score >8, and staged percutaneous coronary intervention. Optimal medical therapy at 5 years, use of statins, on-pump coronary artery bypass grafting, multiple arterial grafts, and higher physical component score and mental component score were associated with lower mortality at 10 years. Numerous scores and prediction models were developed to help individualize risk assessment. Machine learning has emerged as a novel approach for developing risk models.
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Affiliation(s)
- Patrick W. Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Pruthvi C. Revaiah
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Kai Ninomiya
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Nozomi Kotoku
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Marie Angele Morel
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Ted Feldman
- Edwards Lifesciences, Irvine, California, USA
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - David R. Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J. Mack
- Department of Cardiothoracic Surgery, Baylor Scott & White Health, Dallas, Texas, USA
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Kageyama S, Onuma Y, Garg S, Serruys PW. Pitfalls of Simplifying the Original SYNTAX Score: A Temptation That Should Be Resisted. JACC Cardiovasc Interv 2023; 16:1002-1003. [PMID: 37100549 DOI: 10.1016/j.jcin.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 04/28/2023]
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21
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Ninomiya K, Serruys PW, Garg S, Masuda S, Kageyama S, Kotoku N, Morel MA, Taylor C, Puskas JD, Narula J, Schneider U, Doenst T, Tanaka K, De Mey J, La Meir M, Mushtaq S, Bartorelli AL, Pompilio G, Andreini D, Onuma Y. Appropriateness of the modality of revascularization according to the SYNTAX Score II 2020 in the FASTTRACK CABG study: An interim report on patient selection. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 50:34-40. [PMID: 36639338 DOI: 10.1016/j.carrev.2023.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/24/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Personalized long term vital prognosis plays a key role in deciding between percutaneous coronary intervention (PCI) and CABG in patients with complex coronary artery disease. The FASTTRACK CABG trial enrolls patients with the sole guidance of coronary computed tomographic angiography (CCTA) and fractional flow reserve CCTA (FFRCT). The feasibility/non-feasibility of this approach is determined by the surgeon request to have access to the invasive coronary angiography. METHODS This interim analysis, which was requested by the Data and Safety Monitoring Board (DSMB), compared the treatment decision of the "on site" Heart team to the recommended treatment as per the SYNTAX Score II 2020 (SS-2020), which was prospectively assessed by the central core laboratory in the first 57 consecutive patients (half of the planned population) enrolled in this First in Man study. RESULTS The average anatomical SYTAX Score is 35.6 ± 11.5. The SS-2020 predicted 5-year MACE and 10-year all-cause mortality are 14.7 % and 21.6 % following CABG, and 23.0 % and 30.4 % following PCI. Among the enrolled patients the SS-2020 predicts long-term PCI outcomes similar to CABG (absolute risk difference ≤0 % in favor of PCI) in only two patients whilst the remaining 55 patients had a predicted survival benefit with CABG. CONCLUSIONS According to the SS-2020, the first 57 patients recruited into the FASTTRACK CABG trial received the appropriate modality of revascularization and the DSMB allowed the investigators to complete the study.
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Affiliation(s)
- Kai Ninomiya
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Shinichiro Masuda
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Nozomi Kotoku
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Marie Angele Morel
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | | | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, USA
| | - Jagat Narula
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ulrich Schneider
- Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Torsten Doenst
- Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Kaoru Tanaka
- Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Johan De Mey
- Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Mark La Meir
- Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Giulio Pompilio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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Affiliation(s)
- Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ibrahim Akin
- First Department of Medicine, University of Heidelberg Medical Centre, Mannheim, Germany
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23
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Lei X, Liang Q, Fang Y, Xiao Y, Wang D, Dong M, Li J, Yu T. Guidezilla™ guide extension catheter I for transradial coronary intervention. Front Cardiovasc Med 2022; 9:931373. [PMID: 36061563 PMCID: PMC9428470 DOI: 10.3389/fcvm.2022.931373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) is the preferred treatment method for coronary artery diseases (CAD). This study aimed to evaluate the effectiveness and complications of the Guidezilla™ guide extension catheter I (GGEC I) in transradial coronary intervention (TRI). Methods This case series study included patients with CAD who underwent TRI using the GGEC I between August 2016 and January 2019 at the First Affiliated Hospital of Xi'an Jiaotong University. Results A total of 221 patients aged 65.1 ± 9.26 years were included. Coronary angiography results indicated that most patients (77.8%) had triple-vessel lesions, including 47.5% with chronic total occlusion (CTO). A total of 237 target lesions were treated, most being type C lesions (95.8%). The most common indication for GGEC I use was heavy calcification (67%), followed by extreme tortuosity (12.2%), extreme tortuosity and heavy calcification (10.9%), distally located lesion (4.5%), picking up the retrograde wire (3.2%), anomalous vessel origin (1.8%), and releasing the burr incarceration (0.4%). The mean operation time was 58 min, and the overall success rate was 94.1%. Four patients received a drug-coated balloon. No significant differences were found in operation time and success rate among the low (<23), intermediate (23-32), and severe (>32) CAD groups based on SYNTAX score stratification (P > 0.05). Two subacute thrombosis cases each were reported perioperatively, during hospitalization, and at the 1-month follow-up. Conclusion The GGEC I might have advantages for TRI and is unaffected by SYNTAX score stratification.
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Affiliation(s)
- Xinjun Lei
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Qi Liang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yuan Fang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yihui Xiao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Dongqi Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Maozhi Dong
- Department of Cardiovascular Medicine, Shangnan People’s Hospital, Shangluo, China
| | - Jiancheng Li
- Department of Cardiovascular Medicine, Shangluo Central Hospital, Shangluo, China
| | - Ting Yu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Kageyama S, Serruys PW, Garg S, Ninomiya K, Masuda S, Kotoku N, Colombo A, Mack MJ, Banning AP, Morice MC, Witkowski A, Curzen N, Burzotta F, James S, van Geuns RJ, Davierwala PM, Holmes DR, Wood DA, McEvoy JW, Onuma Y. Geographic disparity in 10-year mortality after coronary artery revascularization in the SYNTAXES trial. Int J Cardiol 2022; 368:28-38. [DOI: 10.1016/j.ijcard.2022.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/24/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022]
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Predicted and Observed Mortality at 10 Years in Patients With Bifurcation Lesions in the SYNTAX Trial. JACC Cardiovasc Interv 2022; 15:1231-1242. [PMID: 35595676 DOI: 10.1016/j.jcin.2022.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of bifurcation lesions is associated with higher rates of adverse events, and currently it is unclear whether PCI or coronary artery bypass grafting (CABG) is the safer treatment for these patients at very long-term follow-up. OBJECTIVES The aim of this study was to investigate the impact of bifurcation lesions on individual predicted and observed all-cause 10-year mortality in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial. METHODS In the SYNTAXES (SYNTAX Extended Survival) study, 10-year observed and individual predicted mortality derived from the SYNTAX score 2020 (SS-2020) was compared between patients with ≥1 bifurcation (n = 1,300) and those with no bifurcations (n = 487). RESULTS Among patients treated with PCI, patients with >1 bifurcation lesion compared with those without bifurcation lesions had a significantly higher risk for all-cause death (19.8% vs 30.1%; HR: 1.55; 95% CI: 1.12-2.14; P = 0.007), whereas following CABG, mortality was similar in patients with and those without bifurcation lesions (23.3% vs 23.0%; HR: 0.81; 95% CI: 0.59-1.12; P = 0.207; Pinteraction = 0.006). In PCI patients, a 2-stent vs a 1-stent technique was associated with higher mortality (33.3% vs 25.9%; HR: 1.51; 95% CI: 1.06-2.14; P = 0.021). According to the SS-2020, among those with ≥1 bifurcation, there was equipoise for all-cause mortality between PCI and CABG in 2 quartiles of the population, whereas CABG was superior to PCI in the 2 remaining quartiles. CONCLUSIONS Bifurcation lesions require special attention from the heart team, considering the higher 10-year all-cause mortality associated with PCI. Careful evaluation of bifurcation lesion complexity and calculation of individualized 10-year prognosis using the SS-2020 may therefore be helpful in decision making. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES], NCT03417050; Taxus Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX], NCT00114972).
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26
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Ono M, Hara H, Gao C, Kawashima H, Wang R, O'Leary N, Wykrzykowska JJ, Piek JJ, Mack MJ, Holmes D, Morice MC, Head S, Kappetein AP, Noack T, Davierwala PM, Mohr FW, Garg S, Onuma Y, Serruys PW. Mortality after multivessel revascularisation involving the proximal left anterior descending artery. BRITISH HEART JOURNAL 2022; 108:1784-1791. [PMID: 35732441 PMCID: PMC9626917 DOI: 10.1136/heartjnl-2022-320934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/03/2022] [Indexed: 12/22/2022]
Abstract
Objective We sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD). Methods This post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed. Results Among 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, pinteraction=0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; pinteraction=0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality. Conclusions Among patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG. Trial registration number SYNTAXES: NCT03417050; SYNTAX: NCT00114972.
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Affiliation(s)
- Masafumi Ono
- Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Hironori Hara
- Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland.,Department of Cardiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Rutao Wang
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland.,Department of Cardiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Neil O'Leary
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Joanna J Wykrzykowska
- Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jan J Piek
- Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - David Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Stuart Head
- Department of Cardiothoracic Surgery, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Thilo Noack
- University Department of Cardiac Surgery, Leipzig Heart Center University Hospital, Leipzig, Germany
| | - Piroze M Davierwala
- University Department of Cardiac Surgery, Leipzig Heart Center University Hospital, Leipzig, Germany.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Friedrich W Mohr
- University Department of Cardiac Surgery, Leipzig Heart Center University Hospital, Leipzig, Germany
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
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27
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Gulati M, Burgess S. SYNTAXES, biomarkers and survival in complex coronary artery disease: the intervention of secondary prevention. EUROINTERVENTION 2022; 17:1460-1462. [PMID: 35446258 PMCID: PMC9896389 DOI: 10.4244/eij-e-22-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Sonya Burgess
- University of Sydney, Nepean Hospital, Sydney, Australia,Division of Cardiology, Sydney Southwest Hospital, Sydney, Australia
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28
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Malick WA, Soriano K, Stone GW. Sex-Based Differences in Revascularization Outcomes: Is It Time for a Dedicated Randomized Trial in Women? J Am Heart Assoc 2022; 11:e024281. [PMID: 35189696 PMCID: PMC9075096 DOI: 10.1161/jaha.121.024281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Waqas A Malick
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Kevin Soriano
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY.,Clinical Trials Center Cardiovascular Research Foundation New York NY
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29
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Affiliation(s)
- Zaid I Almarzooq
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center, Boston, MA, USA.,Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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30
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Squiers JJ, DiMaio JM. SYNTAX Score II 2020: A Remake Worth the Price of Admission? J Am Coll Cardiol 2021; 78:1239-1241. [PMID: 34531024 DOI: 10.1016/j.jacc.2021.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/25/2022]
Affiliation(s)
- John J Squiers
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA; Baylor University Medical Center, Dallas, Texas, USA.
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