Author + information
- Received December 28, 2019
- Revision received March 12, 2020
- Accepted April 2, 2020
- Published online May 18, 2020.
- Paul Guedeney, MDa,
- Olivier Barthélémy, MDa,
- Michel Zeitouni, MDa,
- Marie Hauguel-Moreau, MDa,
- Georges Hage, MDa,
- Mathieu Kerneis, MDa,
- Benoit Lattuca, MDa,
- Pavel Overtchouk, MDa,
- Stéphanie Rouanetb,
- Georg Fuernau, MDc,
- Suzanne de Waha-Thiele, MDc,
- Uwe Zeymer, MDd,
- Marcus Sandri, MDe,
- Ibrahim Akin, MDf,
- Steffen Desch, MDe,
- Holger Thiele, MDe,∗ and
- Gilles Montalescot, MD, PhDa,∗∗ (, )@ActionCoeur
- aACTION Study Group, INSERM UMRS_1166, Institut de cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
- bACTION Study Group, Statistician Unit, StatEthic, Levallois-Perret, France
- cUniversity Heart Center Lübeck, Lübeck, Germany
- dKlinikum Ludwigshafen, Institut fur Herzinfarktforschung, Ludwigshafen, Germany
- eHeart Center Leipzig, Leipzig Heart Institute, University of Leipzig, Leipzig, Germany
- fFirst Department of Medicine-Cardiology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
- ↵∗Address for correspondence:
Dr. Gilles Montalescot, ACTION Study Group, Institut de cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47 boulevard de l’hôpital, 75013 Paris, France.
Objectives This study sought to evaluate the prognostic value of the SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) scores in patients undergoing percutaneous coronary intervention (PCI) for multivessel coronary disease with infarct-related cardiogenic shock (CS).
Background The prognostic value of the SYNTAX score in this high-risk setting remains unclear.
Methods The CULPRIT-SHOCK (Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock) trial was an international, open-label trial, where patients presenting with infarct-related CS and multivessel disease were randomized to a culprit-lesion-only or an immediate multivessel PCI strategy. Baseline SYNTAX score was assessed by a central core laboratory and categorized as low SYNTAX score (SS ≤22), intermediate SYNTAX score (22<SS≤32) and high SYNTAX score (SS>32). Adjudicated endpoints of interest were the 30-day risk of death or renal replacement therapy (RRT) and 1-year death. Associations between baseline SYNTAX score and outcomes were assessed using multivariate logistic regression.
Results Pre-PCI SYNTAX score was available in 624 patients, of whom 263 (42.1%), 207 (33.2%) and 154 (24.7%) presented with low, intermediate and high SYNTAX score, respectively. A stepwise increase in the incidence of adverse events was observed from low to intermediate and high SYNTAX score for the 30-day risk of death or RRT and the 1-year risk of death (p < 0.001, for all). After multiple adjustments, intermediate and high SYNTAX score remained strongly associated with 30-day risk of death or renal replacement therapy and 1-year risk of all-cause death. There was no significant interaction between SYNTAX score and the coronary revascularization strategy for any outcomes.
Conclusions In patients presenting with multivessel disease and infarct-related CS, the SYNTAX score was strongly associated with 30-day death or RRT and 1-year mortality.
↵∗ Drs. Thiele and Montalescot contributed equally to this work and are joint senior authors.
The CULPRIT-SHOCK trial was supported by European Union Seventh Framework Program grant agreement 602202, the German Heart Research Foundation, and the German Cardiac Society. Dr. Zeitouni has received research grants from Federation Française de Cardiologie, Institut Servier, and Bristol-Myers Squibb. Dr. Kerneis has received research grants from Sanofi, Institut Servier, and Fédération Française de Cardiologie; and has received consulting fees from Bayer, AstraZeneca, Servier, and Sanofi. Dr. Lattuca has received research grants from Biotronik, Daiichi-Sankyo, Medtronic, and Fédération Française de Cardiologie; consulting fees from Daiichi-Sankyo and Eli Lilly; and lecture fees from AstraZeneca and Novartis. Dr. Zeymer has received personal fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Novartis, Sanofi, MSD, The Medicines Company, Pfizer, Daiichi-Sankyo, Eli Lilly, and Abiomed, outside the submitted work. Dr. Montalescot has received institutional research grants or consulting/lecture fees in the past 2 years from ADIR, Amgen, AstraZeneca, Bayer, Berlin Chimie AG, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham and Women’s Hospital, the Cardiovascular Research Foundation, Celladon, CME Resources, Daiichi-Sankyo, Eli Lilly, Europa, Elsevier, Fédération Française de Cardiologie, Fondazione Anna Maria Sechi per il Cuore, Gilead, Institute of Cardiometabolism And Nutrition, Janssen, Lead-Up, Menarini, Medtronic, MSD, Pfizer, Sanofi, The Medicines Company, TIMI Study Group, and WebMD. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received December 28, 2019.
- Revision received March 12, 2020.
- Accepted April 2, 2020.
- 2020 American College of Cardiology Foundation
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