Impact of completeness of revascularization in complex coronary artery disease as measured with the SYNTAX revascularization index

An SEEDS Substudy

Bo Xu, Nicolas Bettinger, Changdong Guan, Björn Redfors, Yuejin Yang, Bao Li, Yaling Han, Xi Su, Zuyi Yuan, Philippe Genereux

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: We sought to study whether the level of completeness of revascularization as measured by the SYNTAX revascularization index (SRI) independently predicts adverse ischemic events after percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES). Background: The SRI quantifies the proportion of revascularized myocardium. It has been shown to independently predict adverse ischemic events after PCI with first-generation DES. Methods: Among 1,900 patients enrolled in a registry to evaluate safety and effectiveness of everolimus drug-eluting stent (SEEDS) for coronary revascularization, the SRI was calculated and available for 1,851 patients. The patients were stratified into three groups according to the degree of revascularization (SRI = 100% [complete revascularization], SRI = 50 to <100%, and SRI <50%). Two-year mortality and major adverse cardiac events (MACE) were compared between the groups. Results: The SRI ranged from 4–100%, with a mean of 85.4%. Complete revascularization was achieved in 1,190 patients, while the SRI was 50% to <100% in 472 patients and <50% in 189 patients. Two-year mortality and MACE rates were higher in patients with lower SRI. ROC analysis showed an optimal SRI cutoff of 85% for predicting the 2-year mortality risk. An SRI ≥85% was associated with a similar risk of death to complete revascularization. The SRI independently predicted 2-year mortality and MACE. Conclusions: The SRI predicts mortality and adverse ischemic events in patients with complex CAD who underwent contemporary PCI with second-generation DES. Revascularizing ≥85% of the CAD burden was associated with a good prognosis and should be considered as a reasonable goal.

Original languageEnglish (US)
Pages (from-to)541-548
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume89
DOIs
StatePublished - Mar 1 2017

Fingerprint

Drug-Eluting Stents
Coronary Artery Disease
Safety
Percutaneous Coronary Intervention
Mortality
Everolimus
ROC Curve
Registries
Myocardium

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Xu, Bo ; Bettinger, Nicolas ; Guan, Changdong ; Redfors, Björn ; Yang, Yuejin ; Li, Bao ; Han, Yaling ; Su, Xi ; Yuan, Zuyi ; Genereux, Philippe. / Impact of completeness of revascularization in complex coronary artery disease as measured with the SYNTAX revascularization index : An SEEDS Substudy. In: Catheterization and Cardiovascular Interventions. 2017 ; Vol. 89. pp. 541-548.
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title = "Impact of completeness of revascularization in complex coronary artery disease as measured with the SYNTAX revascularization index: An SEEDS Substudy",
abstract = "Objectives: We sought to study whether the level of completeness of revascularization as measured by the SYNTAX revascularization index (SRI) independently predicts adverse ischemic events after percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES). Background: The SRI quantifies the proportion of revascularized myocardium. It has been shown to independently predict adverse ischemic events after PCI with first-generation DES. Methods: Among 1,900 patients enrolled in a registry to evaluate safety and effectiveness of everolimus drug-eluting stent (SEEDS) for coronary revascularization, the SRI was calculated and available for 1,851 patients. The patients were stratified into three groups according to the degree of revascularization (SRI = 100{\%} [complete revascularization], SRI = 50 to <100{\%}, and SRI <50{\%}). Two-year mortality and major adverse cardiac events (MACE) were compared between the groups. Results: The SRI ranged from 4–100{\%}, with a mean of 85.4{\%}. Complete revascularization was achieved in 1,190 patients, while the SRI was 50{\%} to <100{\%} in 472 patients and <50{\%} in 189 patients. Two-year mortality and MACE rates were higher in patients with lower SRI. ROC analysis showed an optimal SRI cutoff of 85{\%} for predicting the 2-year mortality risk. An SRI ≥85{\%} was associated with a similar risk of death to complete revascularization. The SRI independently predicted 2-year mortality and MACE. Conclusions: The SRI predicts mortality and adverse ischemic events in patients with complex CAD who underwent contemporary PCI with second-generation DES. Revascularizing ≥85{\%} of the CAD burden was associated with a good prognosis and should be considered as a reasonable goal.",
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Impact of completeness of revascularization in complex coronary artery disease as measured with the SYNTAX revascularization index : An SEEDS Substudy. / Xu, Bo; Bettinger, Nicolas; Guan, Changdong; Redfors, Björn; Yang, Yuejin; Li, Bao; Han, Yaling; Su, Xi; Yuan, Zuyi; Genereux, Philippe.

In: Catheterization and Cardiovascular Interventions, Vol. 89, 01.03.2017, p. 541-548.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of completeness of revascularization in complex coronary artery disease as measured with the SYNTAX revascularization index

T2 - An SEEDS Substudy

AU - Xu, Bo

AU - Bettinger, Nicolas

AU - Guan, Changdong

AU - Redfors, Björn

AU - Yang, Yuejin

AU - Li, Bao

AU - Han, Yaling

AU - Su, Xi

AU - Yuan, Zuyi

AU - Genereux, Philippe

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Objectives: We sought to study whether the level of completeness of revascularization as measured by the SYNTAX revascularization index (SRI) independently predicts adverse ischemic events after percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES). Background: The SRI quantifies the proportion of revascularized myocardium. It has been shown to independently predict adverse ischemic events after PCI with first-generation DES. Methods: Among 1,900 patients enrolled in a registry to evaluate safety and effectiveness of everolimus drug-eluting stent (SEEDS) for coronary revascularization, the SRI was calculated and available for 1,851 patients. The patients were stratified into three groups according to the degree of revascularization (SRI = 100% [complete revascularization], SRI = 50 to <100%, and SRI <50%). Two-year mortality and major adverse cardiac events (MACE) were compared between the groups. Results: The SRI ranged from 4–100%, with a mean of 85.4%. Complete revascularization was achieved in 1,190 patients, while the SRI was 50% to <100% in 472 patients and <50% in 189 patients. Two-year mortality and MACE rates were higher in patients with lower SRI. ROC analysis showed an optimal SRI cutoff of 85% for predicting the 2-year mortality risk. An SRI ≥85% was associated with a similar risk of death to complete revascularization. The SRI independently predicted 2-year mortality and MACE. Conclusions: The SRI predicts mortality and adverse ischemic events in patients with complex CAD who underwent contemporary PCI with second-generation DES. Revascularizing ≥85% of the CAD burden was associated with a good prognosis and should be considered as a reasonable goal.

AB - Objectives: We sought to study whether the level of completeness of revascularization as measured by the SYNTAX revascularization index (SRI) independently predicts adverse ischemic events after percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES). Background: The SRI quantifies the proportion of revascularized myocardium. It has been shown to independently predict adverse ischemic events after PCI with first-generation DES. Methods: Among 1,900 patients enrolled in a registry to evaluate safety and effectiveness of everolimus drug-eluting stent (SEEDS) for coronary revascularization, the SRI was calculated and available for 1,851 patients. The patients were stratified into three groups according to the degree of revascularization (SRI = 100% [complete revascularization], SRI = 50 to <100%, and SRI <50%). Two-year mortality and major adverse cardiac events (MACE) were compared between the groups. Results: The SRI ranged from 4–100%, with a mean of 85.4%. Complete revascularization was achieved in 1,190 patients, while the SRI was 50% to <100% in 472 patients and <50% in 189 patients. Two-year mortality and MACE rates were higher in patients with lower SRI. ROC analysis showed an optimal SRI cutoff of 85% for predicting the 2-year mortality risk. An SRI ≥85% was associated with a similar risk of death to complete revascularization. The SRI independently predicted 2-year mortality and MACE. Conclusions: The SRI predicts mortality and adverse ischemic events in patients with complex CAD who underwent contemporary PCI with second-generation DES. Revascularizing ≥85% of the CAD burden was associated with a good prognosis and should be considered as a reasonable goal.

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U2 - 10.1002/ccd.26916

DO - 10.1002/ccd.26916

M3 - Article

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