Morice MC, Serruys PW, Kappetein AP, Feldman TE, Stahle E, Colombo A, Mack MJ, Holmes DR, Choi JW, Ruzyllo W, Religa G, Huang J, Roy K, Dawkins KD, Mohr F. Farooq V, Serruys PW, Garcia-Garcia HM, Zhang Y, Bourantas CV, Holmes DR, Mack M, Feldman T, Morice MC, Stahle E, James S, Colombo A, Diletti R, Papafaklis MI, de Vries T, Morel MA, van Es GA, Mohr FW, Dawkins KD, Kappetein AP, Sianos G, Boersma E. Garcia S, Sandoval Y, Roukoz H, Adabag S, Canoniero M, Yannopoulos D, Brilakis ES. The only randomized trial comparing CABG to medical therapy in patients with advanced CKD involved 26 asymptomatic diabetics being assessed for kidney transplantation. Outcome impact of coronary revascularization strategy reclassification with fractional flow reserve at time of diagnostic angiography: insights from a large French multicenter fractional flow reserve registry, Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain? Notwithstanding, observational data from the recent SYNTAX II trial indicate that a multimodal strategy incorporating guideline-based medical treatment, a heart-team based patient selection with use of the SYNTAX score II, intracoronary physiology-guided PCI using a hybrid assessment using iwFR and FFR combined with IVUS-guided stent implantation and contemporary CTO lesion management result in improved clinical outcomes throughout 1 year as compared to a historical PCI cohort derived from the SYNTAX I trial.61 These procedural and technological improvements deserve consideration and further evaluation in appropriately designed revascularization trials. Kirmani BH, Mazhar K, Fabri BM, Pullan DM. The sewing of the distal anastomosis is aided by optical magnification and constitutes the most technically difficult portion of the operation. However, only three of the subgroup analyses, namely diabetes status, tertiles of SYNTAX score, and left main disease would be considered key interactions and primary in nature, backed by prior pathophysiological, clinical and/or anatomical concepts, while the other subgroup analyses with interaction tests would be considered hierarchically subordinate and secondary in nature. 0000010651 00000 n %PDF-1.3 %���� Of note, considering life expectancy of patients included in the latest trials investigating revascularization in the setting of left main CAD, longer follow-up results of these trials are awaited. Among them, the SYNTAX II score is the most intensively studied. In aggregate, there is currently no sufficiently validated score that combines anatomical complexity with relevant clinical variables. Osnabrugge RL, Speir AM, Head SJ, Fonner CE, Fonner E, Kappetein AP, Rich JB. 0000007871 00000 n Casella G, Klauss V, Ottani F, Siebert U, Sangiorgio P, Bracchetti D. Witzenbichler B, Maehara A, Weisz G, Neumann FJ, Rinaldi MJ, Metzger DC, Henry TD, Cox DA, Duffy PL, Brodie BR, Stuckey TD, Mazzaferri ELJr, Xu K, Parise H, Mehran R, Mintz GS, Stone GW. Share on. We also point to the lack of acceptable alternative stratification systems since none of them have been investigated in prospective studies. The randomized BARI trial comparing PCI with use of balloon angioplasty and CABG in selected patients with multivessel CAD reported similar mortality for both revascularization strategies at 5 and 10 years.46,47 In 1992, the Data Safety and Monitoring Board recommended to monitor outcomes among diabetic patients, a subgroup that had not been a priori defined as subgroup in the original protocol. of having a heart attack. The trial used as definition of peri-procedural (within 72 h of the procedure) MI an increase in CK-MB >10 upper limit of normal (ULN) or CK-MB >5ULN in the presence of angiographically documented graft/stent occlusion, new pathological Q-waves in 2 contiguous leads or imaging evidence of new loss of viable myocardium. performed such a test for linear trend of log HRs across ordered SYNTAX tertiles using the same approach as for the primary analysis, a random-effects Cox model with shared frailty reflected by a random intercept to account for variation in baseline risk between trials. Revascularization aims to improve myocardial blood flow thereby reducing ischaemia.51 An important pre-requisite to achieve this goal is the comprehensive assessment and treatment planning of lesions requiring revascularization including treatment optimization. CABG, coronary artery bypass grafting; CAD, coronary artery disease; LAD, left anterior descending artery; PCI, percutaneous coronary intervention. The statistical analysis plan of the SYNTAX trial implemented a hierarchical approach whereby subgroup analyses would only be allowed if the primary endpoint would be met. Mit Flexionstabellen der verschiedenen Fälle und Zeiten Aussprache und relevante Diskussionen Kostenloser Vokabeltrainer The NOBLE trial compared CABG with PCI using new generation DES (Biolimus-Eluting Stent-BES) among 1201 patients with left main CAD (mean SYNTAX score of 23) treated between 2008 and 2015.43 At a median follow-up of 3.1 years, the primary endpoint of death, non-procedural MI, stroke and repeat revascularization occurred more frequently in the PCI than CABG group (29% vs. 19%, HR 1.48, 95% CI 1.11–1.96; P = 0.007). Campos CM, Garcia-Garcia HM, van Klaveren D, Ishibashi Y, Cho YK, Valgimigli M, Raber L, Jonker H, Onuma Y, Farooq V, Garg S, Windecker S, Morel MA, Steyerberg EW, Serruys PW. 0000001979 00000 n 0000001555 00000 n It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Based on the available evidence as established in dedicated RCTs and the distinct anatomico-pathophysiological properties of this lesion, left main CAD needs to be considered as a separate clinical and anatomical entity in practice guidelines. 0000011872 00000 n 3. �100�10�=`4`V`\�p�!���A� ����KN1�21H�U`s`�������)H��8,^�@� ,��� ����g7g5����-�4#� �.� endstream endobj 170 0 obj 238 endobj 142 0 obj << /Type /Page /MediaBox [ 0 0 612 828 ] /Parent 136 0 R /Resources << /Font << /F4 149 0 R /F7 160 0 R /F6 157 0 R /F0 145 0 R /F1 143 0 R /F2 144 0 R /F5 150 0 R /F3 146 0 R >> /XObject << /Im1 168 0 R >> /ProcSet [ /PDF /Text /ImageB ] >> /Contents [ 148 0 R 152 0 R 154 0 R 156 0 R 159 0 R 162 0 R 164 0 R 166 0 R ] /Thumb 124 0 R /CropBox [ 0 0 612 828 ] /Rotate 0 >> endobj 143 0 obj << /Type /Font /Subtype /TrueType /Name /F1 /BaseFont /TimesNewRoman,Bold /Encoding /WinAnsiEncoding >> endobj 144 0 obj << /Type /Font /Subtype /TrueType /Name /F2 /BaseFont /TimesNewRoman /Encoding /WinAnsiEncoding >> endobj 145 0 obj << /Type /Font /Subtype /TrueType /Name /F0 /BaseFont /TimesNewRoman,Bold /Encoding /WinAnsiEncoding >> endobj 146 0 obj << /Type /Font /Subtype /TrueType /Name /F3 /BaseFont /TimesNewRoman /Encoding /WinAnsiEncoding >> endobj 147 0 obj 1306 endobj 148 0 obj << /Filter /FlateDecode /Length 147 0 R >> stream Ann For permissions, please email: journals.permissions@oup.com. Silber S, Albertsson P, Avilés FF, Camici PG, Colombo A, Hamm C, Jørgensen E, Marco J, Nordrehaug J-E, Ruzyllo W, Urban P, Stone GW, Wijns W. Smith SCJr, Feldman TE, Hirshfeld JWJr, Jacobs AK, Kern MJ, King SB3rd, Morrison DA, O’Neill WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Smith SCJr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; Morice MC, Serruys PW, Kappetein AP, Feldman TE, Stahle E, Colombo A, Mack MJ, Holmes DR, Torracca L, van Es GA, Leadley K, Dawkins KD, Mohr F. Park SJ, Kim YH, Park DW, Yun SC, Ahn JM, Song HG, Lee JY, Kim WJ, Kang SJ, Lee SW, Lee CW, Park SW, Chung CH, Lee JW, Lim DS, Rha SW, Lee SG, Gwon HC, Kim HS, Chae IH, Jang Y, Jeong MH, Tahk SJ, Seung KB. Key Words: Coronary artery bypass grafting; Coronary artery disease; Percutaneous coronary intervention ORIGINAL ARTICLE anc ulication. A review of COVID-19-related thrombosis and anticoagulation strategies specific to the Asian population. Sotomi Y, Cavalcante R, van Klaveren D, Ahn JM, Lee CW, de Winter RJ, Wykrzykowska JJ, Onuma Y, Steyerberg EW, Park SJ, Serruys PW. Clinical features of sudden obstruction of the coronary arteries. No. All-cause mortality among patients with multivessel and left main coronary artery disease (All) and separate for multivessel coronary artery disease and left main coronary artery disease stratified by SYNTAX score. Peri-procedural MI was recorded in 3.6% of patients undergoing PCI and 5.9% of patients undergoing CABG (HR 0.61, 95% CI 0.40–0.93; P = 0.02) and ST-segment-elevation MI was noted in 0.7% of patients undergoing PCI and 2.3% of patients undergoing CABG within 30 days of the procedure (HR 0.32, 95% CI 0.14–0.74, P = 0.005). The choice between PCI and CABG is informed by carefully weighing the benefits and risks inherent to the respective revascularization technique as well as local expertise. Prof. Dr. Reinaldo dos Santos, Carnaxide, Portugal, Cardiovascular R&D Unit, Department of Cardiothoracic Surgery, Porto University, Porto, Portugal, Department of Cardiothoracic and Vascular Surgery, German Heart Center, Augustenburger, Platz 1, Berlin, Germany, Department of Cardiovascular Surgery, Charite Berlin, Charite platz 1, Berlin, Germany, Performance of EuroSCORE II in a large US database: implications for transcatheter aortic valve implantation, Comparison of the EuroSCORE II and Society of Thoracic Surgeons 2008 risk tools, Comparison of EuroSCORE II, Original EuroSCORE, and the Society of Thoracic Surgeons Risk Score in Cardiac Surgery Patients, Value of the SYNTAX score for risk assessment in the all-comers population of the randomized multicenter LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial, The prognostic utility of the SYNTAX score on 1-year outcomes after revascularization with zotarolimus- and everolimus-eluting stents: a substudy of the RESOLUTE All Comers Trial, Role of euroSCORE II in predicting long-term outcome after percutaneous catheter intervention for coronary triple vessel disease or left main stenosis, Impact of the SYNTAX scores I and II in patients with diabetes and multivessel coronary disease: a pooled analysis of patient level data from the SYNTAX, PRECOMBAT, and BEST trials, Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial, Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial, The negative impact of incomplete angiographic revascularization on clinical outcomes and its association with total occlusions: the SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial, Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies, Comparison of stenting versus bypass surgery according to the completeness of revascularization in severe coronary artery disease: patient-level pooled analysis of the SYNTAX, PRECOMBAT, and BEST trials, Quantification of incomplete revascularization and its association with five-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial validation of the residual SYNTAX score. From a statistical point of view, the stratified outcome analysis of the SYNTAX trial was therefore formally hypothesis generating. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions, ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons, Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration, Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery, Northern New England Cardiovascular Disease Study Group, Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England, Long-term outcomes of coronary-artery bypass grafting versus stent implantation, Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease, Comparative effectiveness of revascularization strategies, Everolimus-eluting stents or bypass surgery for multivessel coronary disease, Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease, The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease, Cyphering the complexity of coronary artery disease using the SYNTAX score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention, Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data, Interpretation of results of pooled analysis of individual patient data, Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II, Validity of SYNTAX score II for risk stratification of percutaneous coronary interventions: a patient-level pooled analysis of 5,433 patients enrolled in contemporary coronary stent trials, Individual long-term mortality prediction following either coronary stenting or bypass surgery in patients with multivessel and/or unprotected left main disease: an external validation of the SYNTAX Score II Model in the 1,480 patients of the BEST and PRECOMBAT randomized controlled trials, Landmark article (JAMA 1912). 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