TY - JOUR
T1 - The Utility of the SYNTAX Score II and SYNTAX Score 2020 for Identifying Patients with Three-Vessel Disease Eligible for Percutaneous Coronary Intervention in the Multivessel TALENT Trial
T2 - A Prospective Pilot Experience
AU - Ninomiya, Kai
AU - Serruys, Patrick W.
AU - Garg, Scot
AU - Hara, Hironori
AU - Masuda, Shinichiro
AU - Kageyama, Shigetaka
AU - Kotoku, Nozomi
AU - Sevestre, Emelyne
AU - Kumar, Abhishek
AU - O’Kane, Peter
AU - Zaman, Azfar
AU - Farah, Bruno
AU - Magro, Michael
AU - Oemrawsingh, Rohit M.
AU - Möllmann, Helge
AU - Meneveau, Nicolas
AU - Achenbach, Stephan
AU - Lemoine, Julien
AU - Allali, Abdelhakim
AU - Gallagher, Sean
AU - Wykrzykowska, Joanna
AU - Lesiak, Maciej
AU - Silvestri, Marc
AU - Wijns, William
AU - Sharif, Faisal
AU - Onuma, Yoshinobu
N1 - Funding Information: The Multivessel TALENT trial is an investigator-initiated trial sponsored by The National University of Ire- land Galway which received funding from SMT (Saha-janand Medical Technologies, Mumbai, India). Publisher Copyright: Copyright: © 2022 The Author(s).
PY - 2022
Y1 - 2022
N2 - Background: Personalized prognosis plays a vital role in deciding between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD). The aim of this study is to compare the modality of revascularization chosen by the local heart team to that recommended by using individualized predictions of medium, and long-term all-cause mortality amongst patients with 3VD screened in the Multivessel TALENT trial. Methods: The SYNTAX score II (SS-II) and SS-2020 were evaluated in 200 consecutive patients by a core laboratory and compared to the decision of the “on site” heart team. Results: According to the SS-II, CABG was the recommended treatment in 51 patients (25.5%) however 34 (66.6%) of them received PCI. According to SS-2020 the predicted absolute risk differences (ARD) between PCI and CABG were significantly higher in patients receiving CABG compared to those treated by PCI for major adverse cardiovascular and cerebrovascular events, a composite of all-cause mortality, stroke or myocardial infarction at 5-years (8.8 ± 4.6% vs 6.0 ± 4.0%, p < 0.001) and all-cause mortality at 5- (5.2 ± 3.5% vs 3.7 ± 3.0%, p = 0.008) and 10-years (9.3 ± 4.8% vs 6.2 ± 4.2%, p < 0.001). Based on the novel threshold of equipoise (individual absolute risk differences [ARD] <4.5%), 133 patients were eligible for PCI however 23 of them underwent CABG; conversely, amongst the 67 patients where CABG was recommendation (individual ARD >4.5%), only 19 received it. Conclusions: Despite the robustness of the risk models proposed for screening, several deviations from the recommended mode of revascularization were observed by the core laboratory among the first 200 patients with 3VD screened in the Multivessel TALENT trial. Clinical Trial Registration: ClinicalTrials.gov reference: NCT04390672.
AB - Background: Personalized prognosis plays a vital role in deciding between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD). The aim of this study is to compare the modality of revascularization chosen by the local heart team to that recommended by using individualized predictions of medium, and long-term all-cause mortality amongst patients with 3VD screened in the Multivessel TALENT trial. Methods: The SYNTAX score II (SS-II) and SS-2020 were evaluated in 200 consecutive patients by a core laboratory and compared to the decision of the “on site” heart team. Results: According to the SS-II, CABG was the recommended treatment in 51 patients (25.5%) however 34 (66.6%) of them received PCI. According to SS-2020 the predicted absolute risk differences (ARD) between PCI and CABG were significantly higher in patients receiving CABG compared to those treated by PCI for major adverse cardiovascular and cerebrovascular events, a composite of all-cause mortality, stroke or myocardial infarction at 5-years (8.8 ± 4.6% vs 6.0 ± 4.0%, p < 0.001) and all-cause mortality at 5- (5.2 ± 3.5% vs 3.7 ± 3.0%, p = 0.008) and 10-years (9.3 ± 4.8% vs 6.2 ± 4.2%, p < 0.001). Based on the novel threshold of equipoise (individual absolute risk differences [ARD] <4.5%), 133 patients were eligible for PCI however 23 of them underwent CABG; conversely, amongst the 67 patients where CABG was recommendation (individual ARD >4.5%), only 19 received it. Conclusions: Despite the robustness of the risk models proposed for screening, several deviations from the recommended mode of revascularization were observed by the core laboratory among the first 200 patients with 3VD screened in the Multivessel TALENT trial. Clinical Trial Registration: ClinicalTrials.gov reference: NCT04390672.
KW - SYNTAX score
KW - coronary artery bypass grafts (CABG)
KW - percutaneous coronary intervention (PCI)
KW - risk stratification
UR - http://www.scopus.com/inward/record.url?scp=85130122891&partnerID=8YFLogxK
U2 - https://doi.org/10.31083/j.rcm2304133
DO - https://doi.org/10.31083/j.rcm2304133
M3 - Article
SN - 1530-6550
VL - 23
JO - Reviews in cardiovascular medicine
JF - Reviews in cardiovascular medicine
IS - 4
M1 - 133
ER -