Author + information
- Received November 9, 2015
- Revision received February 1, 2016
- Accepted February 11, 2016
- Published online May 23, 2016.
- Angela Migliorini, MD,
- Renato Valenti, MD,
- Guido Parodi, MD,
- Ruben Vergara, MD,
- Piergiovanni Buonamici, MD,
- Giampaolo Cerisano, MD,
- Nazario Carrabba, MD and
- David Antoniucci, MD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. David Antoniucci, Division of Cardiology, Careggi Hospital, Viale Morgagni I-50139, Florence, Italy.
Objectives This study determined angiographic and clinical outcomes after everolimus-eluting stent (EES)–supported percutaneous coronary intervention for unprotected left main disease (ULMD) and high SYNTAX (SYNergy between PCI with TAXus and Cardiac Surgery) trial score (≥33).
Background The SYNTAX trial has shown the superiority of coronary surgery over percutaneous coronary intervention (PCI) in patients with ULMD and complex coronary anatomy. It has been hypothesized that, if newer generation drug-eluting stents had been used in the SYNTAX trial, there would have been a significant reduction in clinical events.
Methods Patients had angiograms scored according to the SYNTAX score algorithm and were divided into 2 groups: those with SYNTAX score of ≥33 and those with <33. The main endpoints were ULMD restenosis and 3-year cardiac mortality.
Results From May 2008 to July 2014, 393 patients underwent EES implantation for ULMD (181 patients had a SYNTAX score ≥33, whereas 212 patients had a SYNTAX score <33). Overall, the restenosis rate was 4.9% (6% in SYNTAX patients scoring ≥33 and 4.1% in SYNTAX patients scoring <33; p = 0.399). On multivariate analysis, the only variable related to restenosis was stent length (odds ratio [OR]: 1.06; 95% confidence interval [CI]: 1.02 to 1.09; p = 0.002). Three-year cardiac survival rates were 99 ± 1% and 98 ± 2% in patients with European system for cardiac operative risk evaluation (EuroSCORE) <6 and SYNTAX <33 and ≥33, respectively, and 90 ± 3% and 87 ± 3% in patients with a EuroSCORE >6 and SYNTAX score <33 and ≥33, respectively. EuroSCORE was strongly related to cardiac mortality, while the SYNTAX score ≥33 was not both in patients with a EuroSCORE <6 or ≥6, and there were no interactions between EuroSCORE and SYNTAX score ≥33.
Conclusions For ULMD patients, high anatomical complexity as defined by a SYNTAX score ≥33 is not predictive of clinical outcome after PCI. (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972)
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 9, 2015.
- Revision received February 1, 2016.
- Accepted February 11, 2016.
- American College of Cardiology Foundation