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Impact of non-respect of SYNTAX score II recommendation for surgery in patients with left main coronary artery disease treated by percutaneous coronary intervention: an EXCEL substudy
- Source :
- European journal of cardio-thoracic surgery, 57(4), 676-683. Elsevier, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 57, 676-683. Elsevier
- Publication Year :
- 2020
-
Abstract
- OBJECTIVES The SYNTAX score II (SSII) was developed from the SYNTAX trial to predict the 4-year all-cause mortality after left main or multivessel disease revascularization and to facilitate the decision-making process. The SSII provides the following treatment recommendations: (i) coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) (equipoise risk), (ii) CABG preferred (excessive risk for PCI) or (iii) PCI preferred (excessive risk for CABG). We sought to externally validate SSII and to investigate the impact of not abiding by the SSII recommendations in the randomized EXCEL trial of PCI versus CABG for left main disease. METHODS The calibration plot of predicted versus observed 4-year mortality was constructed from individual values of SSII in EXCEL. To assess overestimation versus underestimation of predicted mortality risk, an optimal fit regression line with slope and intercept was determined. Prospective treatment recommendations based on SSII were compared with actual treatments and all-cause mortality at 4 years. RESULTS SSII variables were available from EXCEL trial in 1807/1905 (95%) patients. For the entire cohort, discrimination was possibly helpful (C statistic = 0.670). SSII-predicted all-cause mortality at 4 years overestimated the observed mortality, particularly in the highest-risk percentiles, as confirmed by the fit regression line [intercept 2.37 (1.51–3.24), P = 0.003; slope 0.67 (0.61–0.74), P CONCLUSIONS In the EXCEL trial of patients with left main disease, the SSII-predicted 4-year mortality overestimated the 4-year observed mortality with a possibly helpful discrimination. Non-compliance with SSII CABG treatment recommendations (i.e. randomized to PCI) was associated with higher 4-year all-cause mortality.
- Subjects :
- Pulmonary and Respiratory Medicine
medicine.medical_specialty
Left main coronary artery disease
medicine.medical_treatment
Population
Coronary artery bypass grafting
Coronary Artery Disease
030204 cardiovascular system & hematology
Revascularization
Cohort Studies
03 medical and health sciences
Coronary artery bypass surgery
Percutaneous Coronary Intervention
0302 clinical medicine
Internal medicine
medicine
Humans
In patient
Prospective Studies
030212 general & internal medicine
cardiovascular diseases
Coronary Artery Bypass
education
Drug-eluting stents
education.field_of_study
business.industry
Percutaneous coronary intervention
General Medicine
SYNTAX score
Treatment Outcome
surgical procedures, operative
Cohort
Conventional PCI
Cardiology
Surgery
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- Language :
- English
- ISSN :
- 10107940
- Database :
- OpenAIRE
- Journal :
- European journal of cardio-thoracic surgery, 57(4), 676-683. Elsevier, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 57, 676-683. Elsevier
- Accession number :
- edsair.doi.dedup.....85cc23f3353bd8c94ab227809f6a0775