Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS

Yuhei Kobayashi; Jacob Lønborg; Andy Jong; Takeshi Nishi; Bernard De Bruyne; Dan Eik Høfsten; Henning Kelbæk; Jamie Layland; Chang-Wook Nam; Nico H J Pijls; Pim A L Tonino; Julie Warnøe; Keith G Oldroyd; Colin Berry; Thomas Engstrøm; William F Fearon; DANAMI-3-PRIMULTI, FAME, and FAMOUS-NSTEMI Study Investigators

doi:10.1016/j.jacc.2018.06.069

Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS

Yuhei Kobayashi, Jacob Lønborg, Andy Jong, Takeshi Nishi, Bernard De Bruyne, Dan Eik Høfsten, Henning Kelbæk, Jamie Layland, Chang-Wook Nam, Nico H J Pijls, Pim A L Tonino, Julie Warnøe, Keith G Oldroyd, Colin Berry, Thomas Engstrøm, William F Fearon, DANAMI-3-PRIMULTI, FAME, and FAMOUS-NSTEMI Study Investigators

Department of Clinical Medicine

14 Citations (Scopus)

Abstract

Background: The residual SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (RSS) quantitatively assesses angiographic completeness of revascularization after percutaneous coronary intervention (PCI) and has been shown to be a predictor of events after angiography-guided PCI. In stable patients undergoing functionally complete revascularization with fractional flow reserve (FFR) guidance, RSS did not predict outcome. Whether this is also true in patients with acute coronary syndromes (ACS) is unknown. Objectives: The purpose of this study was to determine whether the RSS could predict outcomes in patients with ACS. Methods: From the DANAMI-3-PRIMULTI (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation), and FAMOUS-NSTEMI (Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes) trials, 547 patients presented with ACS and underwent functionally complete revascularization. Major adverse cardiac events (MACE) were defined as the composite endpoint of all-cause death, nonfatal myocardial infarction, and any repeat revascularization. The RSS was based on the recalculation of the SYNTAX score after PCI. We compared differences in 2-year outcome by the RSS subgroups: 0, 1 to <5, 5 to <10, ≥10 (RSS = 0 represents angiographically complete revascularization). Results: The study population consisted of 271 patients with unstable angina/non–ST-segment elevation myocardial infarction and 276 with ST-segment elevation myocardial infarction. The mean RSS was 6.7 ± 5.8. MACE at 2 years occurred in 69 patients (12.6%). Patients with and without MACE had similar RSS after PCI (RSS: 7.2 ± 5.5 vs. 6.6 ± 5.9; p = 0.23). Kaplan-Meier curve analysis showed a similar incidence of MACE regardless of the RSS subgroups (p = 0.54). With and without adjustment of clinical variables, RSS was not a significant predictor of MACE or of each component of MACE. Conclusions: After complete revascularization of functionally significant stenosis by FFR, the extent of residual angiographic disease is not associated with subsequent ischemic events in patients presenting with ACS. These results suggest that the concept of functionally complete revascularization is applicable even in ACS patients. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [F.A.M.E.] NCT00267774; Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes [FAMOUS NSTEMI] NCT01764334; Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [DANAMI-3-PRIMULTI]; NCT01960933)

Original language	English
Journal	Journal of the American College of Cardiology
Volume	72
Issue number	12
Pages (from-to)	1321-1329
Number of pages	9
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2018.06.069
Publication status	Published - 18 Sept 2018

Access to Document

10.1016/j.jacc.2018.06.069

Cite this

Kobayashi, Y., Lønborg, J., Jong, A., Nishi, T., De Bruyne, B., Høfsten, D. E., Kelbæk, H., Layland, J., Nam, C-W., Pijls, N. H. J., Tonino, P. A. L., Warnøe, J., Oldroyd, K. G., Berry, C., Engstrøm, T., Fearon, W. F., & DANAMI-3-PRIMULTI, FAME, and FAMOUS-NSTEMI Study Investigators (2018). Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS. Journal of the American College of Cardiology, 72(12), 1321-1329. https://doi.org/10.1016/j.jacc.2018.06.069

Kobayashi, Y, Lønborg, J, Jong, A, Nishi, T, De Bruyne, B, Høfsten, DE, Kelbæk, H, Layland, J, Nam, C-W, Pijls, NHJ, Tonino, PAL, Warnøe, J, Oldroyd, KG, Berry, C, Engstrøm, T, Fearon, WF & DANAMI-3-PRIMULTI, FAME, and FAMOUS-NSTEMI Study Investigators 2018, 'Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS', Journal of the American College of Cardiology, vol. 72, no. 12, pp. 1321-1329. https://doi.org/10.1016/j.jacc.2018.06.069

@article{24a24f4cbbc147ca9d5f53cfae66f758,

title = "Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS",

abstract = "Background: The residual SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (RSS) quantitatively assesses angiographic completeness of revascularization after percutaneous coronary intervention (PCI) and has been shown to be a predictor of events after angiography-guided PCI. In stable patients undergoing functionally complete revascularization with fractional flow reserve (FFR) guidance, RSS did not predict outcome. Whether this is also true in patients with acute coronary syndromes (ACS) is unknown. Objectives: The purpose of this study was to determine whether the RSS could predict outcomes in patients with ACS. Methods: From the DANAMI-3-PRIMULTI (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation), and FAMOUS-NSTEMI (Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes) trials, 547 patients presented with ACS and underwent functionally complete revascularization. Major adverse cardiac events (MACE) were defined as the composite endpoint of all-cause death, nonfatal myocardial infarction, and any repeat revascularization. The RSS was based on the recalculation of the SYNTAX score after PCI. We compared differences in 2-year outcome by the RSS subgroups: 0, 1 to <5, 5 to <10, ≥10 (RSS = 0 represents angiographically complete revascularization). Results: The study population consisted of 271 patients with unstable angina/non–ST-segment elevation myocardial infarction and 276 with ST-segment elevation myocardial infarction. The mean RSS was 6.7 ± 5.8. MACE at 2 years occurred in 69 patients (12.6%). Patients with and without MACE had similar RSS after PCI (RSS: 7.2 ± 5.5 vs. 6.6 ± 5.9; p = 0.23). Kaplan-Meier curve analysis showed a similar incidence of MACE regardless of the RSS subgroups (p = 0.54). With and without adjustment of clinical variables, RSS was not a significant predictor of MACE or of each component of MACE. Conclusions: After complete revascularization of functionally significant stenosis by FFR, the extent of residual angiographic disease is not associated with subsequent ischemic events in patients presenting with ACS. These results suggest that the concept of functionally complete revascularization is applicable even in ACS patients. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [F.A.M.E.] NCT00267774; Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes [FAMOUS NSTEMI] NCT01764334; Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [DANAMI-3-PRIMULTI]; NCT01960933)",

author = "Yuhei Kobayashi and Jacob L{\o}nborg and Andy Jong and Takeshi Nishi and {De Bruyne}, Bernard and H{\o}fsten, {Dan Eik} and Henning Kelb{\ae}k and Jamie Layland and Chang-Wook Nam and Pijls, {Nico H J} and Tonino, {Pim A L} and Julie Warn{\o}e and Oldroyd, {Keith G} and Colin Berry and Thomas Engstr{\o}m and Fearon, {William F} and {DANAMI-3-PRIMULTI, FAME, and FAMOUS-NSTEMI Study Investigators}",

year = "2018",

month = sep,

day = "18",

doi = "10.1016/j.jacc.2018.06.069",

language = "English",

volume = "72",

pages = "1321--1329",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

number = "12",

}

TY - JOUR

T1 - Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS

AU - Kobayashi, Yuhei

AU - Lønborg, Jacob

AU - Jong, Andy

AU - Nishi, Takeshi

AU - De Bruyne, Bernard

AU - Høfsten, Dan Eik

AU - Kelbæk, Henning

AU - Layland, Jamie

AU - Nam, Chang-Wook

AU - Pijls, Nico H J

AU - Tonino, Pim A L

AU - Warnøe, Julie

AU - Oldroyd, Keith G

AU - Berry, Colin

AU - Engstrøm, Thomas

AU - Fearon, William F

AU - DANAMI-3-PRIMULTI, FAME, and FAMOUS-NSTEMI Study Investigators

PY - 2018/9/18

Y1 - 2018/9/18

N2 - Background: The residual SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (RSS) quantitatively assesses angiographic completeness of revascularization after percutaneous coronary intervention (PCI) and has been shown to be a predictor of events after angiography-guided PCI. In stable patients undergoing functionally complete revascularization with fractional flow reserve (FFR) guidance, RSS did not predict outcome. Whether this is also true in patients with acute coronary syndromes (ACS) is unknown. Objectives: The purpose of this study was to determine whether the RSS could predict outcomes in patients with ACS. Methods: From the DANAMI-3-PRIMULTI (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation), and FAMOUS-NSTEMI (Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes) trials, 547 patients presented with ACS and underwent functionally complete revascularization. Major adverse cardiac events (MACE) were defined as the composite endpoint of all-cause death, nonfatal myocardial infarction, and any repeat revascularization. The RSS was based on the recalculation of the SYNTAX score after PCI. We compared differences in 2-year outcome by the RSS subgroups: 0, 1 to <5, 5 to <10, ≥10 (RSS = 0 represents angiographically complete revascularization). Results: The study population consisted of 271 patients with unstable angina/non–ST-segment elevation myocardial infarction and 276 with ST-segment elevation myocardial infarction. The mean RSS was 6.7 ± 5.8. MACE at 2 years occurred in 69 patients (12.6%). Patients with and without MACE had similar RSS after PCI (RSS: 7.2 ± 5.5 vs. 6.6 ± 5.9; p = 0.23). Kaplan-Meier curve analysis showed a similar incidence of MACE regardless of the RSS subgroups (p = 0.54). With and without adjustment of clinical variables, RSS was not a significant predictor of MACE or of each component of MACE. Conclusions: After complete revascularization of functionally significant stenosis by FFR, the extent of residual angiographic disease is not associated with subsequent ischemic events in patients presenting with ACS. These results suggest that the concept of functionally complete revascularization is applicable even in ACS patients. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [F.A.M.E.] NCT00267774; Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes [FAMOUS NSTEMI] NCT01764334; Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [DANAMI-3-PRIMULTI]; NCT01960933)

AB - Background: The residual SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (RSS) quantitatively assesses angiographic completeness of revascularization after percutaneous coronary intervention (PCI) and has been shown to be a predictor of events after angiography-guided PCI. In stable patients undergoing functionally complete revascularization with fractional flow reserve (FFR) guidance, RSS did not predict outcome. Whether this is also true in patients with acute coronary syndromes (ACS) is unknown. Objectives: The purpose of this study was to determine whether the RSS could predict outcomes in patients with ACS. Methods: From the DANAMI-3-PRIMULTI (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation), and FAMOUS-NSTEMI (Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes) trials, 547 patients presented with ACS and underwent functionally complete revascularization. Major adverse cardiac events (MACE) were defined as the composite endpoint of all-cause death, nonfatal myocardial infarction, and any repeat revascularization. The RSS was based on the recalculation of the SYNTAX score after PCI. We compared differences in 2-year outcome by the RSS subgroups: 0, 1 to <5, 5 to <10, ≥10 (RSS = 0 represents angiographically complete revascularization). Results: The study population consisted of 271 patients with unstable angina/non–ST-segment elevation myocardial infarction and 276 with ST-segment elevation myocardial infarction. The mean RSS was 6.7 ± 5.8. MACE at 2 years occurred in 69 patients (12.6%). Patients with and without MACE had similar RSS after PCI (RSS: 7.2 ± 5.5 vs. 6.6 ± 5.9; p = 0.23). Kaplan-Meier curve analysis showed a similar incidence of MACE regardless of the RSS subgroups (p = 0.54). With and without adjustment of clinical variables, RSS was not a significant predictor of MACE or of each component of MACE. Conclusions: After complete revascularization of functionally significant stenosis by FFR, the extent of residual angiographic disease is not associated with subsequent ischemic events in patients presenting with ACS. These results suggest that the concept of functionally complete revascularization is applicable even in ACS patients. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [F.A.M.E.] NCT00267774; Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes [FAMOUS NSTEMI] NCT01764334; Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [DANAMI-3-PRIMULTI]; NCT01960933)

U2 - 10.1016/j.jacc.2018.06.069

DO - 10.1016/j.jacc.2018.06.069

M3 - Journal article

C2 - 30213322

SN - 0735-1097

VL - 72

SP - 1321

EP - 1329

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 12

ER -

Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS

Abstract

Access to Document

Fingerprint

Cite this