Validation of the SYNTAX Revascularization Index to Quantify Reasonable Level of Incomplete Revascularization After Percutaneous Coronary Intervention

Philippe Genereux, Carlos M. Campos, Vasim Farooq, Christos V. Bourantas, Friedrich W. Mohr, Antonio Colombo, Marie Angèle Morel, Ted E. Feldman, David R. Holmes, Michael J. Mack, Marie Claude Morice, A. Pieter Kappetein, Tullio Palmerini, Gregg W. Stone, Patrick W. Serruys

Research output: Contribution to journalArticle

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Abstract

Incomplete revascularization is common after percutaneous coronary intervention (PCI). Whether a "reasonable" degree of incomplete revascularization is associated with a similar favorable long-term prognosis compared with complete revascularization remains unknown. We sought to quantify the proportion of coronary artery disease burden treated by PCI and evaluate its impact on outcomes using a new prognostic instrument - the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) Revascularization Index (SRI). The baseline SYNTAX score (bSS), the residual SYNTAX score, and the delta SYNTAX score (ΔSS) were determined from 888 angiograms of patients enrolled in the prospective SYNTAX trial. The SRI was then calculated for each patient using the following formula: SRI = (ΔSS/bSS]) × 100. Outcomes were examined according to the proportion of revascularized myocardium (SRI = 100% [complete revascularization], 50% to <100%, and <50%). The Youden index for the SRI was computed to identify the best cutoff for 5-year all-cause mortality. The mean bSS was 28.4 ± 11.5, and after PCI, the mean ΔSS was 23.8 ± 10.9 and the mean residual SYNTAX score was 4.5 ± 6.9. The mean SRI was 85.3 ± 21.2% and was 100% in 385 patients (43.5%), <100% to 50% in 454 patients (51.1%), and <50% in 48 patients (5.4%). Five-year adverse outcomes, including death, were inversely proportional to the SRI. An SRI cutoff of <70% (present in 142 patients [16.0%] after PCI) had the best prognostic accuracy for prediction of death and, by multivariable analysis, was an independent predictor of 5-year mortality (hazard ratio [HR] 4.13, 95% confidence interval [CI] 2.79 to 6.11, p <0.0001). In conclusion, the SRI is a newly described method for quantifying the proportion of coronary artery disease burden treated by PCI. The SRI is a useful tool in assessing the degree of revascularization after PCI, with SRI ≥70% representing a "reasonable" goal for patients with complex coronary artery disease.

Original languageEnglish (US)
Article number21105
Pages (from-to)174-186
Number of pages13
JournalAmerican Journal of Cardiology
Volume116
Issue number2
DOIs
StatePublished - Jul 15 2015

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Percutaneous Coronary Intervention
Coronary Artery Disease
Taxus
Mortality
Thoracic Surgery
Myocardium
Angiography
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Genereux, Philippe ; Campos, Carlos M. ; Farooq, Vasim ; Bourantas, Christos V. ; Mohr, Friedrich W. ; Colombo, Antonio ; Morel, Marie Angèle ; Feldman, Ted E. ; Holmes, David R. ; Mack, Michael J. ; Morice, Marie Claude ; Kappetein, A. Pieter ; Palmerini, Tullio ; Stone, Gregg W. ; Serruys, Patrick W. / Validation of the SYNTAX Revascularization Index to Quantify Reasonable Level of Incomplete Revascularization After Percutaneous Coronary Intervention. In: American Journal of Cardiology. 2015 ; Vol. 116, No. 2. pp. 174-186.
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title = "Validation of the SYNTAX Revascularization Index to Quantify Reasonable Level of Incomplete Revascularization After Percutaneous Coronary Intervention",
abstract = "Incomplete revascularization is common after percutaneous coronary intervention (PCI). Whether a {"}reasonable{"} degree of incomplete revascularization is associated with a similar favorable long-term prognosis compared with complete revascularization remains unknown. We sought to quantify the proportion of coronary artery disease burden treated by PCI and evaluate its impact on outcomes using a new prognostic instrument - the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) Revascularization Index (SRI). The baseline SYNTAX score (bSS), the residual SYNTAX score, and the delta SYNTAX score (ΔSS) were determined from 888 angiograms of patients enrolled in the prospective SYNTAX trial. The SRI was then calculated for each patient using the following formula: SRI = (ΔSS/bSS]) × 100. Outcomes were examined according to the proportion of revascularized myocardium (SRI = 100{\%} [complete revascularization], 50{\%} to <100{\%}, and <50{\%}). The Youden index for the SRI was computed to identify the best cutoff for 5-year all-cause mortality. The mean bSS was 28.4 ± 11.5, and after PCI, the mean ΔSS was 23.8 ± 10.9 and the mean residual SYNTAX score was 4.5 ± 6.9. The mean SRI was 85.3 ± 21.2{\%} and was 100{\%} in 385 patients (43.5{\%}), <100{\%} to 50{\%} in 454 patients (51.1{\%}), and <50{\%} in 48 patients (5.4{\%}). Five-year adverse outcomes, including death, were inversely proportional to the SRI. An SRI cutoff of <70{\%} (present in 142 patients [16.0{\%}] after PCI) had the best prognostic accuracy for prediction of death and, by multivariable analysis, was an independent predictor of 5-year mortality (hazard ratio [HR] 4.13, 95{\%} confidence interval [CI] 2.79 to 6.11, p <0.0001). In conclusion, the SRI is a newly described method for quantifying the proportion of coronary artery disease burden treated by PCI. The SRI is a useful tool in assessing the degree of revascularization after PCI, with SRI ≥70{\%} representing a {"}reasonable{"} goal for patients with complex coronary artery disease.",
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Genereux, P, Campos, CM, Farooq, V, Bourantas, CV, Mohr, FW, Colombo, A, Morel, MA, Feldman, TE, Holmes, DR, Mack, MJ, Morice, MC, Kappetein, AP, Palmerini, T, Stone, GW & Serruys, PW 2015, 'Validation of the SYNTAX Revascularization Index to Quantify Reasonable Level of Incomplete Revascularization After Percutaneous Coronary Intervention', American Journal of Cardiology, vol. 116, no. 2, 21105, pp. 174-186. https://doi.org/10.1016/j.amjcard.2015.03.056

Validation of the SYNTAX Revascularization Index to Quantify Reasonable Level of Incomplete Revascularization After Percutaneous Coronary Intervention. / Genereux, Philippe; Campos, Carlos M.; Farooq, Vasim; Bourantas, Christos V.; Mohr, Friedrich W.; Colombo, Antonio; Morel, Marie Angèle; Feldman, Ted E.; Holmes, David R.; Mack, Michael J.; Morice, Marie Claude; Kappetein, A. Pieter; Palmerini, Tullio; Stone, Gregg W.; Serruys, Patrick W.

In: American Journal of Cardiology, Vol. 116, No. 2, 21105, 15.07.2015, p. 174-186.

Research output: Contribution to journalArticle

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AU - Genereux, Philippe

AU - Campos, Carlos M.

AU - Farooq, Vasim

AU - Bourantas, Christos V.

AU - Mohr, Friedrich W.

AU - Colombo, Antonio

AU - Morel, Marie Angèle

AU - Feldman, Ted E.

AU - Holmes, David R.

AU - Mack, Michael J.

AU - Morice, Marie Claude

AU - Kappetein, A. Pieter

AU - Palmerini, Tullio

AU - Stone, Gregg W.

AU - Serruys, Patrick W.

PY - 2015/7/15

Y1 - 2015/7/15

N2 - Incomplete revascularization is common after percutaneous coronary intervention (PCI). Whether a "reasonable" degree of incomplete revascularization is associated with a similar favorable long-term prognosis compared with complete revascularization remains unknown. We sought to quantify the proportion of coronary artery disease burden treated by PCI and evaluate its impact on outcomes using a new prognostic instrument - the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) Revascularization Index (SRI). The baseline SYNTAX score (bSS), the residual SYNTAX score, and the delta SYNTAX score (ΔSS) were determined from 888 angiograms of patients enrolled in the prospective SYNTAX trial. The SRI was then calculated for each patient using the following formula: SRI = (ΔSS/bSS]) × 100. Outcomes were examined according to the proportion of revascularized myocardium (SRI = 100% [complete revascularization], 50% to <100%, and <50%). The Youden index for the SRI was computed to identify the best cutoff for 5-year all-cause mortality. The mean bSS was 28.4 ± 11.5, and after PCI, the mean ΔSS was 23.8 ± 10.9 and the mean residual SYNTAX score was 4.5 ± 6.9. The mean SRI was 85.3 ± 21.2% and was 100% in 385 patients (43.5%), <100% to 50% in 454 patients (51.1%), and <50% in 48 patients (5.4%). Five-year adverse outcomes, including death, were inversely proportional to the SRI. An SRI cutoff of <70% (present in 142 patients [16.0%] after PCI) had the best prognostic accuracy for prediction of death and, by multivariable analysis, was an independent predictor of 5-year mortality (hazard ratio [HR] 4.13, 95% confidence interval [CI] 2.79 to 6.11, p <0.0001). In conclusion, the SRI is a newly described method for quantifying the proportion of coronary artery disease burden treated by PCI. The SRI is a useful tool in assessing the degree of revascularization after PCI, with SRI ≥70% representing a "reasonable" goal for patients with complex coronary artery disease.

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