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2-Year Results of the AUTAX (Austrian Multivessel TAXUS-Stent) Registry

Beyond the SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) Study

Mariann Gyöngyösi, MD, PhD^_*,_*, Günter Christ, MD^_*, Irene Lang, MD^_*, Gerhard Kreiner, MD^_*, Heinz Sochor, MD^_*, Peter Probst, MD^_*, Thomas Neunteufl, MD^_*, Rosa Badr-Eslam, MD^_*, Susanne Winkler, MD^_*, Noemi Nyolczas, MD^_*, Aniko Posa, PhD^_*, Franz Leisch, MD, Ronald Karnik, MD, Peter Siostrzonek, MD, Stefan Harb, MD^||, Matthias Heigert, MD^¶, Gerald Zenker, MD^#, Werner Benzer, MD^_**, Gerhard Bonner, MD, Alexandra Kaider, MSc, Dietmar Glogar, MD^_* on behalf of the AUTAX Investigators

^_* Department of Cardiology, Medical University of Vienna, Vienna, Austria
Allgemeines Krankenhaus der Stadt Linz, Linz, Austria
Rudolfstiftung Vienna, Vienna, Austria
Krankenhaus Barmherzigen Schwestern, Linz, Austria
^|| Landeskrankenhaus Graz-West, Graz, Austria
^¶ St. Johannes Spital, Salzburg, Austria
^# Landeskrankenhaus, Bruck an der Mur, Austria
^_** Department of Interventional Cardiology, Academic Hospital, Feldkirch, Austria
Confraternität Privatklinik Josefstadt, Vienna, Austria
Core Unit for Medical Statistics and Informatics, Section of Clinical Biometrics, Medical University of Vienna, Vienna, Austria

^_* Reprint requests and correspondence: Dr. Mariann Gyöngyösi, Department of Cardiology, Medical University of Vienna, Austria, Waehringer Guertel 18-20, A-1090 Vienna, Austria (Email: mariann.gyongyosi{at}meduniwien.ac.at).

Objectives: The multicenter AUTAX (Austrian Multivessel TAXUS-Stent) registry investigated the 2-year clinical/angiographic outcomes of patients with multivessel coronary artery disease after implantation of TAXUS Express stents (Boston Scientific, Natick, Massachusetts), in a "real-world" setting.

Background: The AUTAX registry included patients with 2- or 3-vessel disease, with/without previous percutaneous coronary intervention (PCI) and concomitant surgery.

Methods: Patients (n = 441, 64 ± 12 years, 78% men) (n = 1,080 lesions) with possible complete revascularization by PCI were prospectively included. Median clinical follow-up was 753 (quartiles 728 to 775) days after PCI in 95.7%, with control angiography of 78% at 6 months. The primary end point was the composite of major adverse cardiac (nonfatal acute myocardial infarction [AMI], all-cause mortality, target lesion revascularization [TLR]) and cerebrovascular events (MACCE). Potential risk factor effects on 2-year MACCE were evaluated using Cox regression.

Results: Complete revascularization was successful in 90.5%, with left main PCI of 6.8%. Rates of acute, subacute, and late stent thrombosis were 0.7%, 0.5%, and 0.5%. Two-year follow-up identified AMI (1.4%), death (3.6%), stroke (0.2%), and TLR (13.1%), for a composite MACCE of 18.3%. The binary restenosis rate was 10.8%. The median of cumulative SYNTAX score was 23.0 (range 12.0 to 56.5). The SYNTAX score did not predict TLR or MACCE, due to lack of scoring of restenotic or bypass stenoses (29.8%). Age (hazard ratio [HR]: 1.03, p = 0.019) and acute coronary syndrome (HR: 2.1, p = 0.001) were significant predictors of 2-year MACCE. Incomplete revascularization predicted death or AMI (HR: 3.84, p = 0.002).

Conclusions: With the aim of complete revascularization, TAXUS stent implantations can be safe for patients with multivessel disease. The AUTAX registry including patients with post-PCI lesions provides additional information to the SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) study. (Austrian Multivessel TAXUS-Stent Registry; NCT00738686)

Key Words: revascularization • catheterization • stents • coronary disease • SYNTAX score

Abbreviations and Acronyms   AMI = acute myocardial infarction   CABG = coronary artery bypass graft surgery   CAD = coronary artery disease   CI = confidence interval   CK = creatine kinase   DES = drug-eluting stent(s)   HR = hazard ratio   MACCE = major adverse cardiac and cerebrovascular event(s)   MLD = minimal lumen diameter   NSTEMI = non–ST-segment elevation myocardial infarction   PCI = percutaneous coronary intervention   TLR = target lesion revascularization   UA = unstable angina

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