TCT-228: Four-year Follow-up of the SYNTAX Trial: Optimal Revascularization Strategy in Patients with Three-vessel Disease and/or Left Main Disease

Abstract Background The clinical implication of state-of-art PCI at long term follow-up in patients with three vessel disease is undetermined. Purpose The purpose of the study was to investigate whether the favourable outcomes of state-of-the-art PCI in the SYNTAX-II trial, demonstrated up to 2 years, are maintained at 3-year follow-up. Methods The SYNTAX-II study was a multicentre, single arm study that investigated the impact of a state-of-art PCI strategy on clinical outcomes in patients with de novo three vessel coronary artery disease, without left main disease. State-of-art PCI includes: heart team decision-making utilizing the SYNTAX score II, hybrid iFR-FFR decision-making strategy, intravascular ultrasound guided stent implantation, contemporary chronic total occlusion revascularization techniques and guideline-directed medical therapy. The primary endpoint is major adverse cardiac and cerebrovascular events (MACCE – a composite of all-cause death, any stroke, myocardial infarction, or revascularization) at 3 years. Clinical outcomes in SYNTAX-II were compared to the predefined PCI (SYNTAX-I PCI) and coronary artery bypass graft (SYNTAX-I CABG) cohorts from the landmark SYNTAX Trial (SYNTAX-I), selected on the basis of equipoise for long-term (4-year) mortality utilising the SYNTAX Score II. Results Between February 2014 and November 2015, 454 patients out of 708 screened patients were enrolled in SYNTAX-II. In SYNTAX-I, 643 (58.8%) patients with 3VD without left main disease had an equipoise recommendation for CABG or PCI based on the SYNTAX Score II and were used as the comparator. At 2 years, MACCE rate in SYNTAX-II was significantly lower compared to SYNTAX-I PCI (13.2% vs. 21.9%, p=0.001). Furthermore, similar two-year outcomes for MACCE were evident between SYNTAX II-PCI and SYNTAX-I CABG (13.2 vs. 15.1%, p=0.42). Three-year results will be presented at ESC2019. Conclusions Three-year results of his study may offer an attractive option of revascularization strategy in predefined patients with de novo 3VD (SYNTAX Score II inclusion) even if the patients have moderate to severe anatomical complexity (anatomic SYNTAX score >22). Acknowledgement/Funding European Cardiovascular Research Institute (ECRI) with unrestricted research grants from Volcano and Boston Scientific

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Intracoronary Ultrasound Guided Clinical Decision Making in Indeterminate Left Main Disease: 18 Month Follow-up Study

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)84678-5 ◽

1998 ◽

Vol 31 (2) ◽

pp. 224A

Author(s):

S Higano

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Ultrasound Guided ◽

Left Main ◽

Left Main Disease ◽

Intracoronary Ultrasound ◽

Follow Up Study

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Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial

Yearbook of Cardiology ◽

10.1016/j.ycar.2012.01.067 ◽

2012 ◽

Vol 2012 ◽

pp. 221-223

Author(s):

B.J. Gersh

Keyword(s):

Bypass Surgery ◽

Coronary Bypass ◽

Coronary Bypass Surgery ◽

Left Main ◽

Vessel Disease ◽

Drug Eluting

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One-Year Follow-Up Results From the Observational, Multicenter, Prospective, and Controlled Registry: The WALTZ All-Comers Study

Clinical Medicine Insights Cardiology ◽

10.1177/1179546819854059 ◽

2019 ◽

Vol 13 ◽

pp. 117954681985405 ◽

Cited By ~ 2

Author(s):

Alfredo E Rodriguez ◽

Miguel Larribau ◽

Carlos Fernandez-Pereira ◽

Jorge Iravedra ◽

Omar Santaera ◽

...

Keyword(s):

Primary Endpoint ◽

Cardiac Death ◽

Risk Scores ◽

Exclusion Criterion ◽

Cobalt Chromium ◽

Left Main ◽

Cardiac Events ◽

Vessel Disease ◽

Coronary Stent Implantation

The aim of this study was to evaluate 1-year follow-up results in an all “comers” population treated with a new cobalt chromium bare-metal stent (BMS) design. Since August 2016 to March 2017, 201 (9.7% of screening population) consecutive patients undergoing coronary stent implantation in 11 centers in Argentina were prospectively included in our registry. The inclusion criteria were multiple-vessel disease and/or unprotected left main disease, acute coronary syndromes (ACS) with at least one severe (⩾70%) stenosis in any of major epicardial vessel. In-stent restenosis, protected left main stenosis, or impossibility to receive dual-antiplatelet therapy was an exclusion criterion. Major adverse cardiac events (MACE) were the primary endpoint and included cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR); also, all components of the primary endpoint were separately analyzed. Completeness of revascularization was analyzed as post hoc data using residual SYNTAX or ERACI risk scores. Demographic characteristics showed that 6.5% of patients were very elderly, 22.5% have diabetes, 47% have multiple-vessel disease, 67% have ACS, and 32% have ST elevation MI. At a mean of 376 ± 18.1 days of follow-up, MACE was observed in 10.4% of patients: death + MI + cardiovascular accident (CVA) in 3% (6 of 201) and cardiac death + MI + CVA in 1.5% (3 of 201). Residual ERACI score ⩽5 was associated with 98% of event-free survival ( P < .04). In conclusion, this prospective, multicenter, and observational all-comers registry with this novel BMS design showed a low incidence of adverse events at 1 year mainly due to coronary restenosis.

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Left main coronary angioplasty A case report

University Heart Journal ◽

10.3329/uhj.v5i1.3441 ◽

2009 ◽

Vol 5 (1) ◽

pp. 40-41

Author(s):

SM Mustafa Zaman ◽

Masud Sinha ◽

Prodip Kumar Karmakar ◽

Sufia Rahman ◽

Md Harisul Hoque ◽

...

Keyword(s):

Case Report ◽

Chest Pain ◽

Rare Case ◽

Shortness Of Breath ◽

Coronary Angiogram ◽

Class Iii ◽

Left Main ◽

Left Main Disease ◽

Vessel Disease ◽

Triple Vessel Disease

A 52 years lady presented with chest pain and shortness of breath. Chest pain was initially CCS class II and gradually CCS class III. Coronary angiogram reveals triple vessel disease for which she underwent CABG (RSVG to LAD) in December 1999. On January 2003 PTCA with stent (sirolimus - 3 x 15m m) to LCX was done. She again complaints of chest pain after a short symptom less period. Recent coronary angiogram revealed TVD with left main involvement. In this article we will describe a rare case of successful stenting in left main disease. doi: 10.3329/uhj.v5i1.3441 University Heart Journal Vol. 5, No. 1, January 2009 40-41

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Is Complete Revascularisation Mandated for all Patients with Multivessel Coronary Artery Disease?

Interventional Cardiology Review ◽

10.15420/icr.2017:23:1 ◽

2017 ◽

Vol 13 (01) ◽

pp. 45 ◽

Cited By ~ 6

Author(s):

Carlo De Innocentiis ◽

Marco Zimarino ◽

Raffaele De Caterina ◽

◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Artery Bypass ◽

Multivessel Coronary Artery Disease ◽

Left Main ◽

Left Main Disease ◽

Vessel Disease ◽

Myocardial Revascularisation ◽

Artery Disease ◽

Complete Revascularisation

In multivessel coronary artery disease (MVCAD), myocardial revascularisation can be achieved by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), with complete revascularisation on all diseased coronary segments or with incomplete revascularisation on selectively targeted lesions. Complete revascularisation confers a long-term prognostic benefit, but is associated with a higher rate of periprocedural events compared with incomplete revascularisation. In most patients with MVCAD, the main advantage of CABG over PCI is conferred by the achievement of more extensive revascularisation. According to current international guidelines, PCI is generally preferred in single-vessel disease, low-risk MVCAD or isolated left main disease; whereas CABG is usually recommended in patients with complex two-vessel disease, most patients with three-vessel disease and/or non-isolated left main disease. In patients with MVCAD, the choice on revascularisation modality should depend on a multifactorial evaluation, taking into account not only coronary anatomy, the ischaemic burden, myocardial function, age and the presence of comorbidities, but also the adequacy of myocardial revascularisation.

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