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J Am Coll Cardiol. 2017 Jan 31;69(4):395-403. doi: 10.1016/j.jacc.2016.10.067.

SYNTAX Score and Long-Term Outcomes: The BARI-2D Trial.

Collaborators (432)

Detre KM, Kelsey SF, Brooks MM, Orchard TJ, Thomas SB, Tyrrell KS, Rana JS, Averbach F, MacGregor JM, O'Neal SM, Pitluga K, Sansing V, Tranchine M, Crow SW, Bertolet MM, Hardison R, Kip K, Lombardero M, Lu J, Janiszewski S, Protivnak D, Reiser S, Barton S, Guo P, Kushner Y, Michael O, Martin JP, Kania C, Kania M, O'Donnell J, Maxwell RA, Frye RL, Goldberg S, Rosenberg Y, Desvigne-Nickens P, Ershow A, Gordon D, Paltoo D, Jones TLZ, Hueb W, Ramires J, Lopes N, Wajchenberg BL, Martinez EE, Oliveira SA, Ribeiro EE, Perin M, Betti R, Schwartz L, Steiner G, Barolet A, Groenewoud Y, Mighton L, Camelon K, O'Rourke R, Blodgett J, Sako E, Nicastro J, Prescott R, Rihal C, Kennedy F, Barsness G, Basu A, Clavell A, Frye R, Holmes DR Jr., Lerman A, Mullaney C, Reeder G, Rizza R, Schaff H, Smith S, Somers V, Sundt T, Ting H, Wright RS, Helgemoe P, Lesmeister D, Rolbiecki D, Lepe-Montoya L, Escobedo J, Barraza R, Baleón R, Campos A, García P, Lezama C, Miramontes C, Ocampo S, Peñafiel JV, Valdespino A, Verdín R, Albarrán H, Ayala F, Chávez E, Murillo H, Buitrón LV, Rico-Verdin B, Angulo F, Adler D, Halle AA, Ismail-Beigi F, Paranjape S, Mazzurco S, Ridley K, Ramanathan K, Solomon S, Wall B, Weinman D, Touchstone T, Douglas L, Bourassa M, Tardif JC, Chiasson JL, Lavoie MA, Rabasa-Lhoret R, Langelier H, Foucher S, Trudel J, Monrad S, Srinivas V, Zonszein J, Crandall J, Duffy H, Vartolomei E, King S 3rd, Jacobs C, Robertson D, Porter M, Eley M, Nichols E, LaCorte J, Mock M, Rogers W, Ovalle F, Bell D, Misra VK, Hillegass WB, Aqel R, Pierce P, Smith M, Saag L, Vaughn A, Smith D, Grimes T, Rolli S, Hill R, Barrett BD, Morehead C, Doss K, Davidson CJ, Molitch M, Beohar N, Massaro E, Goodreau L, Arroyo F, Neužil P, Pavlickova L, Stehlíková Š, Benedik J, Coling L, Davies R, Glover C, LeMay M, Mesana T, Ooi TC, Silverman M, Sorisky A, Favreau C, McClinton S, Weiss M, Weiss I, Saulle L, Kannam H, Kurylas JC, Vasi L, Douglas J Jr., Ghazzal Z, Sperling L, King S 3rd, Dayamani P, Gebhart S, Basu S, Helmy T, Tangpricha V, Hyde P, Jenkins M, Grant BP, Kent K, Suddath W, Magee M, Julien-Williams P, Reed V, Nassar C, Dagenais G, Garceau C, Auger D, Buller C, Elliott T, Ramanathan K, Ricci D, Fox R, Kolesniak D, Attubato M, Feit F, Richardson S, Sing IP, Slater J, Amendola A, Vargas B, Tsapatsaris N, Woods B, Cushing G, Rutter M, Singh P, DesRochers G, Woodhead G, Gannon D, Campbell NS, Ragosta M, Sarembock I, Powers E, Barrett E, Jahn L, Murie K, Das G, Sigurdsson G, White C, Bantle J, Redmon JB, Kwong C, Tamis-Holland J, Albu J, Hochman JS, Slater J, Wilentz J, Frances S, Tormey D, Pepine C, Smith K, Kennedy L, Brezner K, Curry T, Bleyer F, Albert S, Mooradian A, Plummer S, Fuentes F, Robles R, Lavis V, Gomez J, Iliescu C, Underwood C, Fulton MS, Ramirez JG, Merta J, Scott G, Krishnaswami A, Dowdell L, Berkheimer S, Greenbaum A, Whitehouse F, Pangilinan R, Mann K, Jacobs AK, Sternthal E, Ebner S, Nedeljkovic Z, Beardsley P, Schneider D, Pratley R, Cefalu W, Schnure J, Rowen M, Tilton L, Niederman A, Mata C, Kellerman T, Farmer J, Garber AJ, Kleiman N, Howard N, Nichols D, Pool M, Granger C, Feinglos M, Adams G, Green J, Druken B, Underwood D, Stafford JL, Donner T, Laskey W, Beach D, Lopez J, Davis A, Faxon D, Reutrakul S, Bayer E, Marroquin O, Cohen H, Korytkowski M, Koerbel G, Baxendell L, Rosenfelder D, DeRiso L, Farrell C, Vita T, McGill J, Krone R, Bach R, Recklein C, Luepke KM, Clifton MJ, Farkouh ME, Kim MC, Smith DA, Guzman I, Travis A, O'Keefe J, Forker A, Isley W, Moe R, Kennedy P, Rosson M, Long A, Bates E, Herman W, Pop-Busui R, Duvernoy C, Stevens M, Luciano A, Majors C, Gottlieb SH, Rodriguez A, Herr M, Williams D, Smith RJ, Abbott JD, Laufgraben MJ, Grogan M, Muratori J, Habib G, Marcelli M, Mikati I, Cordero E, Caldwell G, Schechter D, Lorber D, August P, Brown M, Depree P, Huber K, Hanusch-Enserer U, Jordanova N, Cilesiz D, Vogel B, McCallister B Jr., Kleerekoper M, Mandagere K, Urbanic R, Bengston J, Kong BK, Pruitt A, Sanfield J, Carulli C, Churley-Strom R, Magorien R, Osei K, Boyer CC, Lee R, Palumbo P, Wisbey J, Alderman E, Ikeno F, Michael Steffes AS, Nowicki M, Bucksa J, Chaitman B, Eckstein J, Stocke K, Hlatky MA, Boothroyd DB, Melsop KA, Sobel BE, Rowen M, Neimane D, Iskandrian AE, Schaaf MB, Genuth S, Bongarno T, Nesto R, August P, Hultberg K, Gottlieb SH, Albu J, Rosenhouse-Romeo H, Orchard TJ, Pambianco G, Lombardero M, Mock M, Frye RL, Brooks MM, Desvigne-Nickens P, Ershow A, Genuth S, Goldberg S, Gordon D, Hardison R, Jones TLZ, Kelsey S, Nesto R, Orchard T, Paltoo D, Rosenberg Y, Ryan T, Lebovitz H, Brown R, Friesinger G, Horton E, Mason J, Virmani R, Wechsler L, Bairey-Merz CN, Kennedy JW, Gordon D, Antman E, Colwell J, Fowler S, Furberg C, Goldman L, Jennings B, Rankin S.

Author information

1
Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California. Electronic address: fikeno@stanford.edu.
2
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
3
Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
4
Division of Cardiology, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada.
5
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
6
Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.

Abstract

BACKGROUND:

The extent of coronary disease affects clinical outcomes and may predict the effectiveness of coronary revascularization with either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score quantifies the extent of coronary disease.

OBJECTIVES:

This study sought to determine whether SYNTAX scores predicted outcomes and the effectiveness of coronary revascularization compared with medical therapy in the BARI-2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial.

METHODS:

Baseline SYNTAX scores were retrospectively calculated for BARI-2D patients without prior revascularization (N = 1,550) by angiographic laboratory investigators masked to patient characteristics and outcomes. The primary outcome was major cardiovascular events (a composite of death, myocardial infarction, and stroke) over 5 years.

RESULTS:

A mid/high SYNTAX score (≥23) was associated with a higher risk of major cardiovascular events (hazard ratio: 1.36, confidence interval: 1.07 to 1.75, p = 0.01). Patients in the CABG stratum had significantly higher SYNTAX scores: 36% had mid/high SYNTAX scores compared with 13% in the PCI stratum (p < 0.001). Among patients with low SYNTAX scores (≤22), major cardiovascular events did not differ significantly between revascularization and medical therapy, either in the CABG stratum (26.1% vs. 29.9%, p = 0.41) or in the PCI stratum (17.8% vs. 19.2%, p = 0.84). Among patients with mid/high SYNTAX scores, however, major cardiovascular events were lower after revascularization than with medical therapy in the CABG stratum (15.3% vs. 30.3%, p = 0.02), but not in the PCI stratum (35.6% vs. 26.5%, p = 0.12).

CONCLUSIONS:

Among patients with diabetes and stable ischemic heart disease, higher SYNTAX scores predict higher rates of major cardiovascular events and were associated with more favorable outcomes of revascularization compared with medical therapy among patients suitable for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes; NCT00006305).

KEYWORDS:

angiography; coronary disease; ischemia; prognosis; stents; surgery

PMID:
28126156
DOI:
10.1016/j.jacc.2016.10.067
[Indexed for MEDLINE]
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