Impact of the Residual SYNTAX Score on Outcomes of Revascularization in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Disease

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s35730 ◽

2016 ◽

Vol 10 ◽

pp. CMC.S35730 ◽

Cited By ~ 9

Author(s):

Mohamed Loutfi ◽

Sherif Ayad ◽

Mohamed Sobhy

Keyword(s):

Myocardial Infarction ◽

Multivessel Disease ◽

Index Admission ◽

Clinical Indication ◽

Syntax Score ◽

Complete Revascularization ◽

Term Survival ◽

Significant Difference ◽

One Year ◽

Residual Syntax Score

Primary percutaneous coronary intervention (P-PCI) has become the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI) when performed by an experienced team in a timely manner. However, no consensus exists regarding the management of multivessel coronary disease detected at the time of P-PCI. Aim The aim of this study was to evaluate the use of the residual SYNTAX score (rSS) following a complete vs. culprit-only revascularization strategy in patients with STEMI and multivessel disease (MVD) to quantify the extent and complexity of residual coronary stenoses and their impact on adverse ischemic outcomes. Methods Between October 1, 2012, and November 30, 2013, we enrolled 120 consecutive STEMI patients with angiographic patterns of multivessel coronary artery disease (CAD) who had a clinical indication to undergo PCI. The patients were subdivided into those who underwent culprit-only PCI (60 patients) and those who underwent staged-multivessel PCI during the index admission or who were staged within 30 days of the index admission (60 patients). Both the groups were well matched with regard to clinical statuses and lesion characteristics. Clinical outcomes at one year were collected, and the baseline SYNTAX score and rSS were calculated. Results The mean total stent length (31.07 ± 12.7 mm vs. 76.3 ± 14.1 mm) and the number of stents implanted per patient (1.34 ± 0.6 vs. 2.47 ± 0.72) were higher in the staged-PCI group. The rSS was higher in the culprit-only PCI group (9.7 ± 5.7 vs. 1.3 ± 1.99). The angiographic and clinical results after a mean follow-up of 343 ± 75 days demonstrated no significant difference in the occurrence of in-hospital Major Adverse Cardiac and Cerebrovascular Events (MACCE) between both the groups (6.7% vs. 5%, P = 1.000). However, patients treated with staged PCI with an rSS ≤8 had significant reductions in one-year MACCE (10.7% vs. 30.5%, P = 0.020*), death/Myocardial infarction (MI)/Cerebrovascular accident (CVA) (5% vs. 13.8%, P = 0.016*), and repeat revascularization (4.8% vs. 25%, P = 0.001*). We found that culprit-only, higher GRACE risk scores at discharge and an rSS >8 were independent predictors of MACCE at one year. Conclusions Staged PCI that achieves reasonable complete revascularization (rSS ≤8) improves mid-term survival and reduces the incidence of repeat PCI in patients with STEMI and MVD. Nonetheless, large-scale randomized trials are required to establish the optimal revascularization strategy for these high-risk patients.

P3268Prognostic impact of residual SYNTAX score in patients with ST-elevation myocardial infarction and multivessel disease: analysis of an 8-year all-comers registry

European Heart Journal ◽

10.1093/eurheartj/ehx504.p3268 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

A.B. Cid Alvarez ◽

C. Galvao Braga ◽

A. Redondo Dieguez ◽

R. Trillo Nouche ◽

X. Sanmartin Pena ◽

...

Keyword(s):

Myocardial Infarction ◽

Multivessel Disease ◽

St Elevation Myocardial Infarction ◽

Syntax Score ◽

St Elevation ◽

Residual Syntax Score ◽

Disease Analysis

Comparison of 30-Day MACE between Immediate versus Staged Complete Revascularization in Acute Myocardial Infarction with Multivessel Disease, and the Effect of Coronary Lesion Complexity

Medicina ◽

10.3390/medicina55020051 ◽

2019 ◽

Vol 55 (2) ◽

pp. 51

Author(s):

Cem Doğan ◽

Zübeyde Bayram ◽

Murat Çap ◽

Flora Özkalaycı ◽

Tuba Unkun ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiovascular Events ◽

Coronary Intervention ◽

Multivessel Disease ◽

Major Adverse Cardiovascular Events ◽

Syntax Score ◽

Complete Revascularization ◽

Multivariable Model ◽

Coronary Lesion

Background and objective: In patients with acute myocardial infarction and multivessel disease, the timing of intervention to non-culprit lesions is still a matter of debate, especially in patients without shock. This study aimed to compare the effect of multivessel intervention, performed at index percutaneous coronary intervention (PCI) (MVI-I) or index hospitalization (MVI-S), on the 30-day results of acute myocardial infarction (AMI), and to investigate the effect of coronary lesion complexity assessed by the Syntax (Sx) score on the timing of multivessel intervention. Materials and methods: We enrolled 180 patients with MVI-I, and 425 patients with MVI-S. The major adverse cardiovascular events (MACE) for this study were identified as mortality, nonfatal myocardial infarction, nonfatal stroke, acute heart failure, ischemia driven revascularization, major bleeding, and acute renal failure developed within 30 days. Results: The unadjusted MACE rates at 30 days were 11.2% and 5% among those who underwent MVI-I and MVI-S, respectively (OR 3.02; 95% confidence interval (CI) 1.51–6.02; p=0.002). Associations were statistically significant after adjusting for covariates in the penalized multivariable model (adjusted OR 2.06; 95%CI 1.02–4.18; p=0.043), propensity score adjusted multivariable model (adjusted OR 2.46; 95%CI 1.19–5.07; p=0.015), and IPW (adjusted OR 2.11; 95%CI 1.28–3.47; p=0.041). We found that the Syntax score of lesions did not affect the results. Conclusion: MVI-S was associated with a lower incidence of major adverse cardiovascular events within 30 days after discharge.

TCT-22 The residual SYNTAX score predicts prognosis in ST elevation Myocardial infarction in both single vessel and multivessel disease.

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.08.1101 ◽

2018 ◽

Vol 72 (13) ◽

pp. B10

Author(s):

Sonya Burgess ◽

John French ◽

Tuan Nguyen ◽

Melissa Leung ◽

David Richards ◽

...

Keyword(s):

Myocardial Infarction ◽

Multivessel Disease ◽

St Elevation Myocardial Infarction ◽

Syntax Score ◽

Single Vessel ◽

St Elevation ◽

Residual Syntax Score

Comparative Effectiveness of Complete Revascularization versus Infarct Related Artery-only Percutaneous Coronary Revascularization for Multivessel Disease after ST-Segment Elevation Myocardial Infarction

International Cardiovascular Forum Journal ◽

10.17987/icfj.v8i0.256 ◽

2016 ◽

Vol 8 ◽

Author(s):

Joshua Chadwick Jayaraj ◽

Lusine Abrahamyan ◽

Anahit Demirchyan

Keyword(s):

Myocardial Infarction ◽

Primary Endpoint ◽

Coronary Intervention ◽

Multivessel Disease ◽

Index Admission ◽

Complete Revascularization ◽

Font Size ◽

St Segment Elevation ◽

Percutaneous Coronary ◽

Infarct Related Artery

Objectives: The purpose of this study was to evaluate the event free survival from major adverse cardiac events (MACE) for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease as a function of whether they underwent infarct-related artery (IRA) only percutaneous coronary intervention (PCI) or complete revascularization at index admission.Background: The optimal management of patients with STEMI and multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) is uncertain.Methods and Results: STEMI patients with multivessel disease undergoing P-PCI between April 1, 2012, and March 31, 2014, were subdivided into those who underwent in-hospital complete revascularization (n= 150) or IRA-only revascularization (n = 156). Complete revascularization was performed during the index admission of P-PCI. The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 24 months. Patient groups were differed at baseline by gender and prevalence of heart failure. The average door-to-balloon time was significantly higher in the complete revascularization group. The primary endpoint occurred in 11.0% of the complete revascularization group versus 23% in the IRA-only revascularization group (hazard ratio: 0.51; 95% confidence interval: 0.34 to 0.93; p =0.039). There was a significant reduction in death, a non-significant reduction in all primary endpoint components was seen. <span style="font-size: 12.0pt; line-height: 115%; font-family: 'Times New Roman','serif'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;">Conclusions:<span style="font-size: 12.0pt; line-height: 115%; font-family: 'Times New Roman','serif'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;"> In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the primary composite endpoint at 24 months compared with treating only the IRA.

Prognostic impact of residual SYNTAX score in patients with ST-elevation myocardial infarction and multivessel disease: Analysis of an 8-year all-comers registry

International Journal of Cardiology ◽

10.1016/j.ijcard.2017.04.054 ◽

2017 ◽

Vol 243 ◽

pp. 21-26 ◽

Cited By ~ 13

Author(s):

Carlos Galvão Braga ◽

Ana Belén Cid-Alvarez ◽

Alfredo Redondo Diéguez ◽

Belén Alvarez Alvarez ◽

Diego López Otero ◽

...

Keyword(s):

Myocardial Infarction ◽

Multivessel Disease ◽

St Elevation Myocardial Infarction ◽

Syntax Score ◽

Prognostic Impact ◽

St Elevation ◽

Residual Syntax Score ◽

Disease Analysis

Is It Definitely Clear That Long-Term Survival after Breast Cancer Surgery Is Not Affected by Anaesthetics?

Cancers ◽

10.3390/cancers13143390 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3390

Author(s):

Mats Enlund

Keyword(s):

Breast Cancer ◽

Survival Data ◽

Retrospective Studies ◽

Breast Cancer Surgery ◽

Breast Cancer Patients ◽

Term Survival ◽

Long Term Survival ◽

Significant Difference ◽

One Year

Retrospective studies indicate that cancer survival may be affected by the anaesthetic technique. Propofol seems to be a better choice than volatile anaesthetics, such as sevoflurane. The first two retrospective studies suggested better long-term survival with propofol, but not for breast cancer. Subsequent retrospective studies from Asia indicated the same. When data from seven Swedish hospitals were analysed, including 6305 breast cancer patients, different analyses gave different results, from a non-significant difference in survival to a remarkably large difference in favour of propofol, an illustration of the innate weakness in the retrospective design. The largest randomised clinical trial, registered on clinicaltrial.gov, with survival as an outcome is the Cancer and Anesthesia study. Patients are here randomised to propofol or sevoflurane. The inclusion of patients with breast cancer was completed in autumn 2017. Delayed by the pandemic, one-year survival data for the cohort were presented in November 2020. Due to the extremely good short-term survival for breast cancer, one-year survival is of less interest for this disease. As the inclusions took almost five years, there was also a trend to observe. Unsurprisingly, no difference was found in one-year survival between the two groups, and the trend indicated no difference either.

Coronary endarterectomy in coronary artery disease: Factors affecting graft patency and survival

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211006851 ◽

2021 ◽

pp. 021849232110068

Author(s):

Simon CY Chow ◽

Jacky YK Ho ◽

Micky WT Kwok ◽

Takuya Fujikawa ◽

Kevin Lim ◽

...

Keyword(s):

Myocardial Infarction ◽

Graft Patency ◽

Complete Revascularization ◽

Coronary Endarterectomy ◽

Factors Affecting ◽

Early Results ◽

Cerebrovascular Events ◽

Obtuse Marginal ◽

One Year

Background Coronary endarterectomy aims to improve completeness of revascularization in patients with occluded coronary vessels. The benefits of coronary endarterectomy remain uncertain. The aim of this study was to evaluate short-term surgical outcomes and factors affecting graft patency post-coronary endarterectomy. Methods Between 2009 and 2019, 81 consecutive patients who had coronary endarterectomy done were evaluated for their perioperative and early results. A total of 36 patients with follow-up coronary studies were included in patency analysis. Mortality rates, major adverse cardiac and cerebrovascular events, and graft patency were outcomes of interest. Survival and risk factor analysis were performed with Kaplan–Meier and logistic regression analysis. Results The average age of the cohort was 61.9 ± 9.29 years. Complete revascularization rate was 95.4% post-coronary endarterectomy. The 30-day and 1-year mortality was 2.5 and 6.2%, respectively. One-year major adverse cardiac and cerebrovascular events rate was 11.1%. Periprocedural myocardial infarction rate was 7.4%. Three patients required repeat revascularization within a mean follow-up duration of 49.6 ± 36.5 months. Overall graft patency was 89.2% at 20.2 months and graft patency post-coronary endarterectomy was 85.4%. Arterial grafts showed 100% patency. Vein grafts to endarterectomized obtuse marginal branch had patency rates of 33.3%. Multiple endarterectomies were associated with worse one-year major adverse cardiac and cerebrovascular events (OR: 28.6 ± 1.16; P = 0.003). Conclusions Coronary endarterectomy facilitates completeness of revascularization and does not increase early mortality. Graft patency post-coronary endarterectomy on obtuse marginal artery was suboptimal. Judicious use of coronary endarterectomy should be practiced to balance the need of completeness of revascularization against the risk of myocardial infarction.

Complete Revascularization Versus Culprit Lesion Only in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2019.01.248 ◽

2019 ◽

Vol 12 (8) ◽

pp. 721-730 ◽

Cited By ~ 4

Author(s):

Kasper Kyhl ◽

Kiril Aleksov Ahtarovski ◽

Lars Nepper-Christensen ◽

Kathrine Ekström ◽

Adam Ali Ghotbi ◽

...

Keyword(s):

Myocardial Infarction ◽

Multivessel Disease ◽

Complete Revascularization ◽

Culprit Lesion ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials

European Heart Journal ◽

10.1093/eurheartj/ehz896 ◽

2019 ◽

Vol 41 (42) ◽

pp. 4103-4110 ◽

Cited By ~ 13

Author(s):

Rita Pavasini ◽

Simone Biscaglia ◽

Emanuele Barbato ◽

Matteo Tebaldi ◽

Dariusz Dudek ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Cardiovascular Death ◽

Multivessel Disease ◽

Complete Revascularization ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Abstract Aims The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). Methods and results Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39–0.97, I2 = 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36–150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55–0.84, I2 = 0% and HR 0.29, 95% CI 0.22–0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37–55) for MI and 8 (95% CI 5–13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56–1.16, I2 = 27%) was not affected by the revascularization strategy. Conclusion In a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization.

PROGRESSIVE ATHEROSCLEROTIC CORONARY ARTERIES IN PATIENTS WITH SEVERAL ISCHEMIC EVENTS IN ANAMNESIS

"Medical & pharmaceutical journal "Pulse" ◽

10.26787/nydha-2686-6838-2021-23-9-113-119 ◽

2021 ◽

pp. 113-119

Author(s):

Parkhomenko O.M. ◽

Lozhkina N.G.

Keyword(s):

Myocardial Infarction ◽

Coronary Arteries ◽

Clinical Signs ◽

Risk Groups ◽

Adverse Outcomes ◽

Syntax Score ◽

One Year ◽

The Moment ◽

Microsoft Office ◽

Ischemic Events

Вackground. Progressive atherosclerosis is accompanied by unfavorable clinical outcomes; study and understanding of this process is necessary to identify the appropriate risk groups. Purpose of the study to study the dynamics of atherosclerotic lesions of the coronary arteries in patients with several ischemic events in history. Patient Characterization and Research Methods. The present subanalysis included 51 patients with recurrent nonfatal myocardial infarction (MI) out of the initially included 100 patients with index MI. All 100 patients had a history of two or more ischemic coronary or cerebral events, which corresponds to the clinical signs of progressive atherosclerosis. The dynamics of the degree of coronary stenosis from the moment of index MI to repeated MI was assessed according to the data of selective coronary angiography. The statistical program Microsoft Office Excel 2019 was used. Results. All patients with recurrent myocardial infarction (51 people) had signs of progression of coronary artery stenosis: "mild" progression - 82.3%, "moderate" and "severe" - 15.6% and 2.1%, respectively. SYNTAX Score> 22.5 points was a predictor of one-year adverse outcomes: OR 6.349, CI (2.548-15.823). The results obtained make it possible to distinguish a group of patients with accelerated atherosclerosis syndrome in order to stratify the risk and optimally manage this complex category of patients.