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Cited by 85Coronary Interventions and DiagnosticsCardiac Imaging and DiagnosticsCardiac and Coronary Surgery Techniques

SYNTAX Score and Long-Term Outcomes

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Ikeno, Fumiaki, Brooks, Maria Mori, Nakagawa, Kaori, Kim, Min-Kyu, Kaneda, Hideaki, Mitsutake, Yoshiaki, Vlachos, Helen A., Schwartz, Leonard +436 more·2017·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2016.10.067
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Abstract

Background The extent of coronary disease affects clinical outcomes and may predict the effectiveness of coronary revascularization with either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score quantifies the extent of coronary disease.Objectives This study sought to determine whether SYNTAX scores predicted outcomes and the effectiveness of coronary revascularization compared with medical therapy in the BARI-2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial.Methods Baseline SYNTAX scores were retrospectively calculated for BARI-2D patients without prior revascularization (N = 1,550) by angiographic laboratory investigators masked to patient characteristics and outcomes. The primary outcome was major cardiovascular events (a composite of death, myocardial infarction, and stroke) over 5 years.Results A mid/high SYNTAX score (≥23) was associated with a higher risk of major cardiovascular events (hazard ratio: 1.36, confidence interval: 1.07 to 1.75, p = 0.01). Patients in the CABG stratum had significantly higher SYNTAX scores: 36% had mid/high SYNTAX scores compared with 13% in the PCI stratum (p < 0.001). Among patients with low SYNTAX scores (≤22), major cardiovascular events did not differ significantly between revascularization and medical therapy, either in the CABG stratum (26.1% vs. 29.9%, p = 0.41) or in the PCI stratum (17.8% vs. 19.2%, p = 0.84). Among patients with mid/high SYNTAX scores, however, major cardiovascular events were lower after revascularization than with medical therapy in the CABG stratum (15.3% vs. 30.3%, p = 0.02), but not in the PCI stratum (35.6% vs. 26.5%, p = 0.12).Conclusions Among patients with diabetes and stable ischemic heart disease, higher SYNTAX scores predict higher rates of major cardiovascular events and were associated with more favorable outcomes of revascularization compared with medical therapy among patients suitable for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes; NCT00006305).

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Ikeno, F., Brooks, M. M., Nakagawa, K., Kim, M.-K., Kaneda, H., Mitsutake, Y., Vlachos, H. A., Schwartz, L., Frye, R. L., Kelsey, S. F., Waseda, K., Hlatky, M. A., Detre, K. M., Kelsey, S. F., Brooks, M. M., Orchard, T. J., Thomas, S. B., Tyrrell, K. S., Rana, J. S., Averbach, F., MacGregor, J. M., O’Neal, S. M., Pitluga, K., Sansing, V., Tranchine, M., Crow, S. W., Bertolet, M. (., Hardison, R., Kip, K., Lombardero, M., Lu, J., Janiszewski, S., Protivnak, D., Reiser, S., Barton, S., Guo, P., Kushner, Y., Michael, O., Martin, J. P., Kania, C., Kania, M., O’Donnell, J., Maxwell, R. A., Frye, R. L., Goldberg, S., Rosenberg, Y., Desvigne-Nickens, P., Ershow, A., Gordon, D., Paltoo, D., Jones, T. L. Z., Hueb, W., Ramires, J., Lopes, N., Wajchenberg, B. L., Martinez, E. E., Oliveira, S. A., Ribeiro, E. E., Perin, M., Betti, R., Schwartz, L., Steiner, G., Barolet, A., Groenewoud, Y., Mighton, L., Camelon, K., O’Rourke, R., Blodgett, J., Sako, E., Nicastro, J., Prescott, R., Rihal, C., Kennedy, F., Barsness, G., Basu, A., Clavell, A., Frye, R., Holmes, D. R., Lerman, A., Mullaney, C., Reeder, G., Rizza, R., Schaff, H., Smith, S., Somers, V., Sundt, T., Ting, H., Wright, R. S., Helgemoe, P., Lesmeister, D., Rolbiecki, D., Lepe-Montoya, L., Escobedo, J., Barraza, R., Baleón, R., Campos, A., García, P., Lezama, C., Miramontes, C., Ocampo, S., Peñafiel, J. V., Valdespino, A., Verdín, R., Albarrán, H., Ayala, F., Chávez, E., Murillo, H., Buitrón, L. V., Rico-Verdin, B., Angulo, F., Adler, D., Halle, A. A., Ismail-Beigi, F., Paranjape, S., Mazzurco, S., Ridley, K., Ramanathan, K., Solomon, S., Wall, B., Weinman, D., Touchstone, T., Douglas, L., Bourassa, M., Tardif, J.-C., Chiasson, J.-L., Lavoie, M. A., Rabasa-Lhoret, R., Langelier, H., Foucher, S., Trudel, J., Monrad, S., Srinivas, V., Zonszein, J., Crandall, J., Duffy, H., Vartolomei, E., King, S., Jacobs, C., Robertson, D., Porter, M., Eley, M., Nichols, E., LaCorte, J., Mock, M., Rogers, W., Ovalle, F., Bell, D., Misra, V. K., Hillegass, W. B., Aqel, R., Pierce, P., Smith, M., Saag, L., Vaughn, A., Smith, D., Grimes, T., Rolli, S., Hill, R., Barrett, B. D., Morehead, C., Doss, K., Davidson, C. J., Molitch, M., Beohar, N., Massaro, E., Goodreau, L., Arroyo, F., Neužil, P., Pavlickova, L., Stehlíková, Š., Benedik, J., Coling, L., Davies, R., Glover, C., LeMay, M., Mesana, T., Ooi, T. C., Silverman, M., Sorisky, A., Favreau, C., McClinton, S., Weiss, M., Weiss, I., Saulle, L., Kannam, H., Kurylas, J. C., Vasi, L., Douglas, J., Ghazzal, Z., Sperling, L., King, S., Dayamani, P., Gebhart, S., Basu, S., Helmy, T., Tangpricha, V., Hyde, P., Jenkins, M., Grant, B. P., Kent, K., Suddath, W., Magee, M., Julien-Williams, P., Reed, V., Nassar, C., Dagenais, G., Garceau, C., Auger, D., Buller, C., Elliott, T., Ramanathan, K., Ricci, D., Fox, R., Kolesniak, D., Attubato, M., Feit, F., Richardson, S., Sing, I. P., Slater, J., Amendola, A., Vargas, B., Tsapatsaris, N., Woods, B., Cushing, G., Rutter, M., Singh, P., DesRochers, G., Woodhead, G., Gannon, D., Campbell, N. S., Ragosta, M., Sarembock, I., Powers, E., Barrett, E., Jahn, L., Murie, K., Das, G., Sigurdsson, G., White, C., Bantle, J., Redmon, J. B., Kwong, C., Tamis-Holland, J., Albu, J., Hochman, J. S., Slater, J., Wilentz, J., Frances, S., Tormey, D., Pepine, C., Smith, K., Kennedy, L., Brezner, K., Curry, T., Bleyer, F., Albert, S., Mooradian, A., Plummer, S., Fuentes, F., Robles, R., Lavis, V., Gomez, J., Iliescu, C., Underwood, C., Fulton, M. S., Ramirez, J. G., Merta, J., Scott, G., Krishnaswami, A., Dowdell, L., Berkheimer, S., Greenbaum, A., Whitehouse, F., Pangilinan, R., Mann, K., Jacobs, A. K., Sternthal, E., Ebner, S., Nedeljkovic, Z., Beardsley, P., Schneider, D., Pratley, R., Cefalu, W., Schnure, J., Rowen, M., Tilton, L., Niederman, A., Mata, C., Kellerman, T., Farmer, J., Garber, A. J., Kleiman, N., Howard, N., Nichols, D., Pool, M., Granger, C., Feinglos, M., Adams, G., Green, J., Druken, B., Underwood, D., Stafford, J. L., Donner, T., Laskey, W., Beach, D., Lopez, J., Davis, A., Faxon, D., Reutrakul, S., Bayer, E., Marroquin, O., Cohen, H., Korytkowski, M., Koerbel, G., Baxendell, L., Rosenfelder, D., DeRiso, L., Farrell, C., Vita, T., McGill, J., Krone, R., Bach, R., Recklein, C., Luepke, K. M., Clifton, M. J., Farkouh, M. E., Kim, M. C., Smith, D. A., Guzman, I., Travis, A., O’Keefe, J., Forker, A., Isley, W., Moe, R., Kennedy, P., Rosson, M., Long, A., Bates, E., Herman, W., Pop-Busui, R., Duvernoy, C., Stevens, M., Luciano, A., Majors, C., Gottlieb, S. H., Rodriguez, A., Herr, M., Williams, D., Smith, R. J., Abbott, J. D., Laufgraben, M. J., Grogan, M., Muratori, J., Habib, G., Marcelli, M., Mikati, I., Cordero, E., Caldwell, G., Schechter, D., Lorber, D., August, P., Brown, M., Depree, P., Huber, K., Hanusch-Enserer, U., Jordanova, N., Cilesiz, D., Vogel, B., McCallister, B., Kleerekoper, M., Mandagere, K., Urbanic, R., Bengston, J., Kong, B. K., Pruitt, A., Sanfield, J., Carulli, C., Churley-Strom, R., Magorien, R., Osei, K., Boyer, C. C., Lee, R., Palumbo, P., Wisbey, J., Alderman, E., Ikeno, F., Michael Steffes, A. S., Nowicki, M., Bucksa, J., Chaitman, B., Eckstein, J., Stocke, K., Hlatky, M. A., Boothroyd, D. B., Melsop, K. A., Sobel, B. E., Rowen, M., Neimane, D., Iskandrian, A. E., Schaaf, M. B., Genuth, S., Bongarno, T., Nesto, R., August, P., Hultberg, K., Gottlieb, S. H., Albu, J., Rosenhouse-Romeo, H., Orchard, T. J., Pambianco, G., Lombardero, M., Mock, M., Frye, R. L., Brooks, M. M., Desvigne-Nickens, P., Ershow, A., Genuth, S., Goldberg, S., Gordon, D., Hardison, R., Jones, T. L. Z., Kelsey, S., Nesto, R., Orchard, T., Paltoo, D., Rosenberg, Y., Ryan, T., Lebovitz, H., Brown, R., Friesinger, G., Horton, E., Mason, J., Virmani, R., Wechsler, L., Bairey-Merz, C. N., Kennedy, J. W., Gordon, D., Antman, E., Colwell, J., Fowler, S., Furberg, C., Goldman, L., Jennings, B., & Rankin, S.
Affiliations
  • Stanford Medicine (US)
  • University of Pittsburgh (US)
  • Mayo Clinic (US)
  • University Health Network (CA)
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2017-01
Volume
69
Issue
4
Pages
395-403
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2016.10.067
OpenAlex
W2581982962
Cited by
85
References
23
Citations by year
2026: 6 · 2025: 8 · 2024: 15 · 2023: 7 · 2022: 5 · 2021: 9 · 2020: 11 · 2019: 7 · 2018: 8 · 2017: 9
FWCI
9.81
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • GlaxoSmithKline
  • National Heart, Lung, and Blood Institute
  • National Institute of Diabetes and Digestive and Kidney Diseases
Topics
  • Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
Keywords
SYNTAX score, coronary artery disease extent, coronary revascularization, coronary artery bypass grafting, percutaneous coronary intervention, diabetes mellitus, stable coronary artery disease, major adverse cardiovascular events, BARI 2D trial, risk prediction, treatment comparison, long-term outcomes, Taxus stent, coronary angiography, myocardial infarction
MeSH terms
Aged, Coronary Artery Bypass, Coronary Disease, Female, Humans, Male, Middle Aged, Research Design, Retrospective Studies, Treatment Outcome, Coronary Angiography, Diabetes Complications, Percutaneous Coronary Intervention

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