Document Detail


SYNTAX score and Clinical SYNTAX score as predictors of very long-term clinical outcomes in patients undergoing percutaneous coronary interventions: a substudy of SIRolimus-eluting stent compared with pacliTAXel-eluting stent for coronary revascularization (SIRTAX) trial.
MedLine Citation:
PMID:  21951630     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: To investigate the ability of SYNTAX score and Clinical SYNTAX score (CSS) to predict very long-term outcomes in an all-comers population receiving drug-eluting stents.
METHODS AND RESULTS: The SYNTAX score was retrospectively calculated in 848 patients enrolled in the SIRolimus-eluting stent compared with pacliTAXel-Eluting Stent for coronary revascularization (SIRTAX) trial. The CSS was calculated using age, and baseline left ventricular ejection fraction and creatinine clearance. A stratified post hoc comparison was performed for all-cause mortality, cardiac death, myocardial infarction (MI), ischaemia-driven target lesion revascularization (TLR), definite stent thrombosis, and major adverse cardiac events (MACE) at 1- and 5-year follow-up. Tertiles for SYNTAX score and CSS were defined as SS(LOW) ≤ 7, 7< SS(MID) ≤ 14, SS(HIGH) >14 and CSS(LOW) ≤ 8.0, 8.0 <CSS(MID) ≤ 17.0 and CSS(HIGH) >17.0, respectively. Major adverse cardiac events rates were significantly higher in SS(HIGH) compared with SS(LOW) at 1- and 5-year follow-up, which was also seen at 5 years for all-cause mortality, cardiac death, MI, and TLR. Stratifying outcomes across CSS tertiles confirmed and augmented these results. Within CSS(HIGH), 5-year MACE increased with use of paclitaxel- compared with sirolimus-eluting stents (34.7 vs. 21.3%, P = 0.008). SYNTAX score and CSS were independent predictors of 5-year MACE; CSS was an independent predictor for 5-year mortality. Areas-under-the-curve for SYNTAX score and CSS for 5-year MACE were 0.61 (0.56-0.65) and 0.62 (0.57-0.67), for 5-year all-cause mortality 0.58 (0.51-0.65) and 0.66 (0.59-0.73) and for 5-year cardiac death 0.63 (0.54-0.72) and 0.72 (0.63-0.81), respectively.
CONCLUSION: SYNTAX score and to a greater extent CSS were able to stratify risk for very long-term adverse clinical outcomes in an all-comers population receiving drug-eluting stents. Predictive accuracy for 5-year all-cause mortality was improved using CSS.
TRIAL REGISTRATION NUMBER: NCT00297661.
Authors:
Chrysafios Girasis; Scot Garg; Lorenz Räber; Giovanna Sarno; Marie-Angèle Morel; Hector M Garcia-Garcia; Thomas F Lüscher; Patrick W Serruys; Stephan Windecker
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2011-09-27
Journal Detail:
Title:  European heart journal     Volume:  32     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-15     Completed Date:  2012-02-09     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  3115-27     Citation Subset:  IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00297661
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary / methods,  mortality
Coronary Stenosis / mortality,  therapy*
Drug-Eluting Stents*
Female
Humans
Male
Middle Aged
Myocardial Revascularization / methods,  mortality
Paclitaxel / administration & dosage*
Predictive Value of Tests
Prospective Studies
ROC Curve
Retrospective Studies
Severity of Illness Index*
Sirolimus / administration & dosage*
Treatment Outcome
Tubulin Modulators / administration & dosage*
Chemical
Reg. No./Substance:
0/Tubulin Modulators; 33069-62-4/Paclitaxel; W36ZG6FT64/Sirolimus

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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