Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study.
<h4>Aims</h4> <p>To investigate if recent technical and procedural developments in percutaneous coronary intervention (PCI) significantly influence outcomes in appropriately selected patients with three-vessel (3VD) coronary artery disease.</p> <h4>Methods and Results&...
| Egile Nagusiak: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Formatua: | Journal article |
| Hizkuntza: | English |
| Argitaratua: |
Oxford University Press
2017
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| _version_ | 1826268998376882176 |
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| author | Escaned, J Collet, C Ryan, N De Maria, G Walsh, S Sabate, M Davies, J Lesiak, M Moreno, R Cruz-Gonzalez, I Hoole, S Ej West, N Piek, J Zaman, A Fath-Ordoubadi, F Stables, R Appleby, C van Mieghem, N van Geuns, R Uren, N Zueco, J Buszman, P Iñiguez, A Goicolea, J Hildick-Smith, D Ochala, A Dudek, D Hanratty, C Cavalcante, R Kappetein, A Taggart, D van Es, G Morel, M de Vries, T Onuma, Y Farooq, V Serruys, P Banning, A |
| author_facet | Escaned, J Collet, C Ryan, N De Maria, G Walsh, S Sabate, M Davies, J Lesiak, M Moreno, R Cruz-Gonzalez, I Hoole, S Ej West, N Piek, J Zaman, A Fath-Ordoubadi, F Stables, R Appleby, C van Mieghem, N van Geuns, R Uren, N Zueco, J Buszman, P Iñiguez, A Goicolea, J Hildick-Smith, D Ochala, A Dudek, D Hanratty, C Cavalcante, R Kappetein, A Taggart, D van Es, G Morel, M de Vries, T Onuma, Y Farooq, V Serruys, P Banning, A |
| author_sort | Escaned, J |
| collection | OXFORD |
| description | <h4>Aims</h4> <p>To investigate if recent technical and procedural developments in percutaneous coronary intervention (PCI) significantly influence outcomes in appropriately selected patients with three-vessel (3VD) coronary artery disease.</p> <h4>Methods and Results</h4> <p>The SYNTAX II study is a multicenter, all-comers, open-label, single arm study that investigated the impact of a contemporary PCI strategy on clinical outcomes in patients with 3VD in 22 centres from four European countries. The SYNTAX-II strategy includes: heart team decision-making utilizing the SYNTAX Score II (a clinical tool combining anatomical and clinical factors), coronary physiology guided revascularisation, implantation of thin strut bioresorbable-polymer drug-eluting stents, intravascular ultrasound (IVUS) guided stent implantation, contemporary chronic total occlusion revascularisation techniques and guideline-directed medical therapy. The rate of major adverse cardiac and cerebrovascular events (MACCE [composite of all-cause death, cerebrovascular event, any myocardial infarction and any revascularisation]) at one year was compared to a predefined PCI cohort from the original SYNTAX-I trial selected on the basis of equipoise 4-year mortality between CABG and PCI. As an exploratory endpoint, comparisons were made with the historical CABG cohort of the original SYNTAX-I trial. Overall 708 patients were screened and discussed within the heart team; 454 patients were deemed appropriate to undergo PCI. At one year, the SYNTAX-II strategy was superior to the equipoise-derived SYNTAX-I PCI cohort (MACCE SYNTAX-II 10.6% vs. SYNTAX-I 17.4%; HR 0.58, 95% CI 0.39–0.85, P = 0.006). This difference was driven by a significant reduction in the incidence of MI (HR 0.27, 95% CI 0.11–0.70, P = 0.007) and revascularisation (HR 0.57, 95% CI 0.37–0.9, P = 0.015). Rates of all-cause death (HR 0.69, 95% CI 0.27–1.73, P = 0.43) and stroke (HR 0.69, 95% CI 0.10–4.89, P = 0.71) were similar. The rate of definite stent thrombosis was significantly lower in SYNTAX-II (HR 0.26, 95% CI 0.07–0.97, P = 0.045).</p> <h4>Conclusion</h4> <p>At one year, clinical outcomes with the SYNTAX-II strategy were associated with improved clinical results compared to the PCI performed in comparable patients from the original SYNTAX-I trial. Longer term follow-up is awaited and a randomized clinical trial with contemporary CABG is warranted.</p> |
| first_indexed | 2024-03-06T21:18:09Z |
| format | Journal article |
| id | oxford-uuid:4081daf8-9e9b-4ef5-a64d-4bff8e04a12f |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T21:18:09Z |
| publishDate | 2017 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:4081daf8-9e9b-4ef5-a64d-4bff8e04a12f2022-03-26T14:38:23ZClinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:4081daf8-9e9b-4ef5-a64d-4bff8e04a12fEnglishSymplectic Elements at OxfordOxford University Press2017Escaned, JCollet, CRyan, NDe Maria, GWalsh, SSabate, MDavies, JLesiak, MMoreno, RCruz-Gonzalez, IHoole, SEj West, NPiek, JZaman, AFath-Ordoubadi, FStables, RAppleby, Cvan Mieghem, Nvan Geuns, RUren, NZueco, JBuszman, PIñiguez, AGoicolea, JHildick-Smith, DOchala, ADudek, DHanratty, CCavalcante, RKappetein, ATaggart, Dvan Es, GMorel, Mde Vries, TOnuma, YFarooq, VSerruys, PBanning, A <h4>Aims</h4> <p>To investigate if recent technical and procedural developments in percutaneous coronary intervention (PCI) significantly influence outcomes in appropriately selected patients with three-vessel (3VD) coronary artery disease.</p> <h4>Methods and Results</h4> <p>The SYNTAX II study is a multicenter, all-comers, open-label, single arm study that investigated the impact of a contemporary PCI strategy on clinical outcomes in patients with 3VD in 22 centres from four European countries. The SYNTAX-II strategy includes: heart team decision-making utilizing the SYNTAX Score II (a clinical tool combining anatomical and clinical factors), coronary physiology guided revascularisation, implantation of thin strut bioresorbable-polymer drug-eluting stents, intravascular ultrasound (IVUS) guided stent implantation, contemporary chronic total occlusion revascularisation techniques and guideline-directed medical therapy. The rate of major adverse cardiac and cerebrovascular events (MACCE [composite of all-cause death, cerebrovascular event, any myocardial infarction and any revascularisation]) at one year was compared to a predefined PCI cohort from the original SYNTAX-I trial selected on the basis of equipoise 4-year mortality between CABG and PCI. As an exploratory endpoint, comparisons were made with the historical CABG cohort of the original SYNTAX-I trial. Overall 708 patients were screened and discussed within the heart team; 454 patients were deemed appropriate to undergo PCI. At one year, the SYNTAX-II strategy was superior to the equipoise-derived SYNTAX-I PCI cohort (MACCE SYNTAX-II 10.6% vs. SYNTAX-I 17.4%; HR 0.58, 95% CI 0.39–0.85, P = 0.006). This difference was driven by a significant reduction in the incidence of MI (HR 0.27, 95% CI 0.11–0.70, P = 0.007) and revascularisation (HR 0.57, 95% CI 0.37–0.9, P = 0.015). Rates of all-cause death (HR 0.69, 95% CI 0.27–1.73, P = 0.43) and stroke (HR 0.69, 95% CI 0.10–4.89, P = 0.71) were similar. The rate of definite stent thrombosis was significantly lower in SYNTAX-II (HR 0.26, 95% CI 0.07–0.97, P = 0.045).</p> <h4>Conclusion</h4> <p>At one year, clinical outcomes with the SYNTAX-II strategy were associated with improved clinical results compared to the PCI performed in comparable patients from the original SYNTAX-I trial. Longer term follow-up is awaited and a randomized clinical trial with contemporary CABG is warranted.</p> |
| spellingShingle | Escaned, J Collet, C Ryan, N De Maria, G Walsh, S Sabate, M Davies, J Lesiak, M Moreno, R Cruz-Gonzalez, I Hoole, S Ej West, N Piek, J Zaman, A Fath-Ordoubadi, F Stables, R Appleby, C van Mieghem, N van Geuns, R Uren, N Zueco, J Buszman, P Iñiguez, A Goicolea, J Hildick-Smith, D Ochala, A Dudek, D Hanratty, C Cavalcante, R Kappetein, A Taggart, D van Es, G Morel, M de Vries, T Onuma, Y Farooq, V Serruys, P Banning, A Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. |
| title | Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. |
| title_full | Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. |
| title_fullStr | Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. |
| title_full_unstemmed | Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. |
| title_short | Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. |
| title_sort | clinical outcomes of state of the art percutaneous coronary revascularization in patients with de novo three vessel disease 1 year results of the syntax ii study |
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