Identify Unsuitable Patients with Left Main Coronary Artery Disease in Intermediate SYNTAX Scores Treated by Percutaneous Coronary Intervention

Authors

  • Chunxiao Zhang Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Department of Cardiovascular Surgery, Peking University International Hospital, Beijing, China
  • Yaguang Zheng Connell School of Nursing, Boston College, Boston, MA, USA
  • Xinbin Liu Department of Cardiovascular Surgery, Aerospace Center Hospital, Beijing, China
  • Yutong Cheng Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
  • Yang Liu Department of Cardiology, No. 305 Hospital of People’s Liberation Army (PLA), Beijing, China
  • Yan Yao Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
  • Xinguo Wang Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
  • Jianping Xu Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases; Department of Cardiovascular Surgery, Peking University International Hospital, Beijing, China

DOI:

https://doi.org/10.1532/hsf.1741

Keywords:

intermediate SYNTAX score, percutaneous coronary intervention (PCI), left main (LM), repeat revascularization, major adverse cerebro-cardiovascular events (MACCE)

Abstract

Background: With the follow-up extending to 5 years, the outcomes of SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) trial were comparable between coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in left-main (LM) patients with intermediate SYNTAX scores of 23–32. A subdivision depending on SYNTAX score will help to identify unsuitable LM patients with intermediate SYNTAX scores to receive PCI treatment.

Methods: Between January 2011 and June 2013, 104 patients with LM Coronary Artery Disease (CAD) undergoing PCI were selected retrospectively. We compared clinical outcomes in patients with SYNTAX score <27 and ≥27. The follow-up time was 25.23 ± 7.92 months. Kaplan-Meier survival analyses and Cox proportional hazards models were used to compare various outcomes between two groups.

Results: Higher rates of repeated revascularization (18.2% versus 4.2%, P = .027) and major adverse cerebro-cardiovascular events (MACCE) (24.2% versus 7.0%,
P = .014) were shown in patients with SYNTAX score ≥ 27. After multivariate adjustment, a significant higher risk of repeated revascularization (hazard ratio: 6.25, 95% confidence interval: 1.48 to 26.37, P = .013) and MACCE (hazard ratio: 4.49, 95% confidence interval: 1.41 to 14.35, P = .011) were also found in patients with SYNTAX score ≥ 27.

Conclusions: Based on the higher rate of repeated revascularization and MACCE, patients with LM CAD and intermediate SYNTAX scores will need a subdivision to identity the one not benefit from PCI. CABG is still the standard treatment method for patients of LM CAD with a SYNTAX score of ≥ 27.

Author Biographies

Chunxiao Zhang, Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Department of Cardiovascular Surgery, Peking University International Hospital, Beijing, China

Department of Cardiovascular Surgery

Yaguang Zheng, Connell School of Nursing, Boston College, Boston, MA, USA

Connell School of Nursing

Xinbin Liu, Department of Cardiovascular Surgery, Aerospace Center Hospital, Beijing, China

Department of Cardiovascular Surgery

Yutong Cheng, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

Department of Cardiology

Yang Liu, Department of Cardiology, No. 305 Hospital of People’s Liberation Army (PLA), Beijing, China

Department of Cardiology

Yan Yao, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

Department of Cardiology

Xinguo Wang, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

Department of Cardiology

Jianping Xu, Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases; Department of Cardiovascular Surgery, Peking University International Hospital, Beijing, China

Depatment of Cardiovascular Surgery

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Published

2017-12-21

How to Cite

Zhang, C., Zheng, Y., Liu, X., Cheng, Y., Liu, Y., Yao, Y., Wang, X., & Xu, J. (2017). Identify Unsuitable Patients with Left Main Coronary Artery Disease in Intermediate SYNTAX Scores Treated by Percutaneous Coronary Intervention. The Heart Surgery Forum, 20(6), E258-E262. https://doi.org/10.1532/hsf.1741

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Section

Articles