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Patrick W Serruys - One of the best experts on this subject based on the ideXlab platform.
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external validation of the SYNTAX Score ii 2020
Journal of the American College of Cardiology, 2021Co-Authors: Hironori Hara, Ewout W Steyerberg, David Van Klaveren, Yoshinobu Onuma, Hiroki Shiomi, Patrick W Serruys, Scot Garg, David M Kent, Takeshi KimuraAbstract:Abstract Background The SYNTAX Score II 2020 (SSII-2020) was derived from cross correlation and externally validated in randomized trials to predict death and major adverse cardiac and cerebrovascular events (MACE) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with 3-vessel disease (3VD) and/or left main coronary artery disease (LMCAD). Objectives The authors aimed to investigate the SSII-2020’s value in identifying the safest modality of revascularization in a non-randomized setting. Methods Five-year mortality and MACE were assessed in 7,362 patients with 3VD and/or LMCAD enrolled in a Japanese PCI/CABG registry. The discriminative abilities of the SSII-2020 were assessed using Harrell’s C statistic. Agreement between observed and predicted event rates following PCI or CABG and treatment benefit (absolute risk difference [ARD]) for these outcomes were assessed by calibration plots. Results The SSII-2020 for 5-year mortality well predicted the prognosis after PCI and CABG (C-index = 0.72, intercept = −0.11, slope = 0.92). When patients were grouped according to the predicted 5-year mortality ARD, Conclusions The SSII-2020 for predicting 5-year death has the potential to support decision making on revascularization in patients with 3VD and/or LMCAD.
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redevelopment and validation of the SYNTAX Score ii to individualise decision making between percutaneous and surgical revascularisation in patients with complex coronary artery disease secondary analysis of the multicentre randomised controlled SYNTAXes trial with external cohort validation
The Lancet, 2020Co-Authors: Kuniaki Takahashi, Patrick W Serruys, Michael E Farkouh, Valentin Fuster, Seungjung Park, John A Spertus, David J Cohen, Dukwoo Park, Jungmin AhnAbstract:Summary Background Randomised controlled trials are considered the gold standard for testing the efficacy of novel therapeutic interventions, and typically report the average treatment effect as a summary result. As the result of treatment can vary between patients, basing treatment decisions for individual patients on the overall average treatment effect could be suboptimal. We aimed to develop an individualised decision making tool to select an optimal revascularisation strategy in patients with complex coronary artery disease. Methods The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries between March, 2005, and April, 2007. Patients with de-novo three-vessel and left main coronary artery disease were randomly assigned (1:1) to either the percutaneous coronary intervention (PCI) group or coronary artery bypass grafting (CABG) group. The SYNTAXES study ascertained 10-year all-cause deaths. We used Cox regression to develop a clinical prognostic index for predicting death over a 10-year period, which was combined, in a second stage, with assigned treatment (PCI or CABG) and two prespecified effect-modifiers, which were selected on the basis of previous evidence: disease type (three-vessel disease or left main coronary artery disease) and anatomical SYNTAX Score. We used similar techniques to develop a model to predict the 5-year risk of major adverse cardiovascular events (defined as a composite of all-cause death, non-fatal stroke, or non-fatal myocardial infarction) in patients receiving PCI or CABG. We then assessed the ability of these models to predict the risk of death or a major adverse cardiovascular event, and their differences (ie, the estimated benefit of CABG versus PCI by calculating the absolute risk difference between the two strategies) by cross-validation with the SYNTAX trial (n=1800 participants) and external validation in the pooled population (n=3380 participants) of the FREEDOM, BEST, and PRECOMBAT trials. The concordance (C)-index was used to measure discriminative ability, and calibration plots were used to assess the degree of agreement between predictions and observations. Findings At cross-validation, the newly developed SYNTAX Score II, termed SYNTAX Score II 2020, showed a helpful discriminative ability in both treatment groups for predicting 10-year all-cause deaths (C-index=0·73 [95% CI 0·69–0·76] for PCI and 0·73 [0·69–0·76] for CABG) and 5-year major adverse cardiovascular events (C-index=0·65 [0·61–0·69] for PCI and C-index=0·71 [0·67–0·75] for CABG). At external validation, the SYNTAX Score II 2020 showed helpful discrimination (C-index=0·67 [0·63–0·70] for PCI and C-index=0·62 [0·58–0·66] for CABG) and good calibration for predicting 5-year major adverse cardiovascular events. The estimated treatment benefit of CABG over PCI varied substantially among patients in the trial population, and the benefit predictions were well calibrated. Interpretation The SYNTAX Score II 2020 for predicting 10-year deaths and 5-year major adverse cardiovascular events can help to identify individuals who will benefit from either CABG or PCI, thereby supporting heart teams, patients, and their families to select optimal revascularisation strategies. Funding The German Heart Research Foundation and the Patient-Centered Outcomes Research Institute.
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tct 239 impact of nonrespect of SYNTAX Score ii recommendations for surgery in patients with complex coronary artery disease treated by pci a pooled analysis of 3 280 randomized patients SYNTAX best and precombat trials
Journal of the American College of Cardiology, 2019Co-Authors: Patrick W Serruys, Yoshinobu Onuma, Kuniaki Takahashi, Ply Chichareon, Rodrigo Modolo, Norihiro Kogame, Chun Chin Chang, Mariusz Tomaniak, Jungmin Ahn, Seungjung ParkAbstract:The SYNTAX Score II (SSII) was developed to predict 4-year all-cause mortality after left main (LM) or multivessel disease revascularization and to facilitate the decision-making process by providing the following treatment recommendations: 1) coronary artery bypass grafting (CABG) or percutaneous
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significant association among residual SYNTAX Score non culprit major adverse cardiac events and greyscale and virtual histology intravascular ultrasound findings a substudy from the prospect study
Eurointervention, 2019Co-Authors: Akiko Fujino, Gregg W Stone, Patrick W Serruys, Tadayuki Kadohira, Bjorn Redfors, Akiko Maehara, Gary S Mintz, Philippe GenereuxAbstract:Aims Residual SYNTAX Score (rSS) is known to be associated with cardiac events. We sought to investigate the association between rSS and greyscale and virtual histology (VH)-intravascular ultrasound (IVUS) plaque morphology, and the association between rSS and non-culprit-related major adverse cardiac events (MACE) using data from the PROSPECT study. Methods and results A total of 697 patients with acute coronary syndromes were enrolled in the PROSPECT study. Three-vessel greyscale and VH-IVUS were performed. Among them, 688 patients with paired baseline SS or SYNTAX Score and rSS were identified and divided into three groups - rSS=0 (n=184), 0 8 (n=140). MACE was defined as the composite of cardiac death, cardiac arrest, myocardial infarction, or rehospitalisation for unstable or progressive angina. There was a significant difference in the three-year non-culprit-related MACE rates among the three groups (5.7% versus 11.9% versus 19.7%, lowest to highest rSS; p=0.004) mainly due to rehospitalisation for unstable or progressive angina. On multivariable analysis, patients with ≥1 lesion with plaque burden ≥70% or ≥1 lesion with a minimum lumen area ≤4 mm2 and total dense calcium volume per patient were significantly correlated with rSS. Insulin-treated diabetes mellitus, rSS, and patients with ≥1 lesion with plaque burden ≥70% were independent predictors of non-culprit-related MACE. Conclusions Plaque morphology based on greyscale IVUS and VH-IVUS was significantly correlated with rSS, and rSS and plaque burden ≥70% independently predicted non-culprit-related MACE.
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SYNTAX Score ii predicts long term mortality in patients with one or two vessel disease
PLOS ONE, 2018Co-Authors: Maxime M Vroegindewey, Patrick W Serruys, Robert Jan Van Geuns, Jurgen Ligthart, Annesophie Schuurman, Rohit M Oemrawsingh, Isabella Kardys, Joost Daemen, Eric BoersmaAbstract:Objective SYNTAX Score II (SSII) is a long-term mortality prediction model to guide the decision making of the heart-team between coronary artery bypass grafting or percutaneous coronary intervention (PCI) in patients with left main or three-vessel coronary artery disease. This study aims to investigate the long-term predictive value of SSII for all-cause mortality in patients with one- or two-vessel disease undergoing PCI. Methods A total of 628 patients (76% men, mean age: 61±10 years) undergoing PCI due to stable angina pectoris (43%) or acute coronary syndrome (57%), included between January 2008 and June 2013, were eligible for the current study. SSII was calculated using the original SYNTAX Score website (www.SYNTAXScore.com). Cox regression analysis was used to assess the association between continuous SSII and long-term all-cause mortality. The area under the receiver-operating characteristic curve was used to assess the performance of SSII. Results SSII ranged from 6.6 to 58.2 (median: 20.4, interquartile range: 16.1–26.8). In multivariable analysis, SSII proved to be an independent significant predictor for 4.5-year mortality (hazard ratio per point increase: 1.10; 95% confidence interval: 1.07–1.13; p<0.001). In terms of discrimination, SSII had a concordance index of 0.77. Conclusion In addition to its established value in patients with left main and three-vessel disease, SSII may also predict long-term mortality in PCI-treated patients with one- or two-vessel disease.
Vasim Farooq - One of the best experts on this subject based on the ideXlab platform.
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appropriateness of myocardial revascularization assessed by the SYNTAX Score ii in a country without cardiac surgery facilities proust study
International Journal of Cardiology, 2017Co-Authors: Bojan Stanetic, Carlos M Campos, Vasim Farooq, Miodrag Ostojic, Kurt Huber, Tamara Kovacevicpreradovic, Jelena Marinkovic, Patrick W SerruysAbstract:Abstract Background/objectives The SYNTAX Score II (SSII) was proposed as a novel approach for objective individualized decision-making for optimal myocardial revascularization i.e. percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. We sought to investigate how many lives may be saved by SSII use. Methods A total number of 651 consecutive SSII-naive-patients with complex coronary artery disease who were treated with PCI (n=409) or referred to other institutions for CABG (n=242) were included. All-cause mortality was ascertained in 96% of patients. The SSII was calculated for each patient. Results Based on the SSII treatment recommendation, CABG would have been the treatment of choice in 257/651 (39.5%) patients, PCI in 7/651 (1.1%) patients and CABG or PCI in 387/651 (59.4%) patients. Out of 257 patients in whom the treatment recommendation by SSII was CABG, 113/257 (44.0%) patients had actually CABG, while the remaining 144/257 (56.0%) underwent PCI. It was shown that 144/257 patients with treatment recommendations in favour of CABG who were treated with PCI had significantly higher mortality at 4years when compared with patients with SSII treatment recommendation for PCI or equally favouring CABG and PCI (12.5% vs. 0.0% vs. 6.9%, respectively, P=0.04). Conclusion The intuitive decision-making for choosing the optimal myocardial revascularization method differed predominantly from the SSII recommendation for CABG. The discordance between the SSII recommended revascularization strategy and the clinical decision was associated with a higher 4-year mortality i.e. one life may be saved if SSII would be calculated and followed consequently in 18 patients.
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risk stratification in 3 vessel coronary artery disease applying the SYNTAX Score ii in the heart team discussion of the SYNTAX ii trial
Catheterization and Cardiovascular Interventions, 2015Co-Authors: Carlos M Campos, Vasim Farooq, Yoshinobu Onuma, Hector M Garciagarcia, Bojan Stanetic, Yuki Ishibashi, Simon J Walsh, Javier Escaned, Adrian P BanningAbstract:Background Heart Team (HT) and the SYNTAX Score II (SSII) have been integrated to the contemporary guidelines with the aim to provide a multidisciplinary decision-making process between coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI). Aims To prospectively assess the agreement between the HT decision and the SSII recommendation regarding the revascularization strategy in patients with 3-vessel coronary artery disease (CAD) of the SYNTAX II trial. Methods The SSII predicts the 4-year mortality of an individual patient both after PCI and after CABG. Patients were treated by PCI when the SSII predicted a mortality risk favoring PCI or when risk predictions were equipoise between PCI and CABG. However, the HT could overrule the SSII and recommend either CABG or PCI. Results A total of 202 patients have been screened and 24 did not fulfill inclusion criteria. The median age was 67.0 (IQR 59.0-73.3), and 167 (82.7%) were male. The HT endorsed SSII treatment recommendation, for CABG or PCI, in 152 patients (85.4%). Three patients had preference for PCI, irrespective of the HT decision. The main reason for the HT to overrule the SSII and recommend CABG was the prospect of a more complete revascularization (21 of 25 patients). Patients recommended for CABG by the HT had significantly higher anatomical SYNTAX Score (P = 0.03) and higher predicted mortality risk for PCI (P = 0.04) when compared with patients that were enrolled in the trial. Conclusion The SYNTAX Score II showed to be a suitable tool for guiding treatment decisions of patients with 3-vessel coronary artery disease being endorsed by the HT in the vast majority of the patients that have been enrolled in the SYNTAX II trial.
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risk stratification in 3 vessel coronary artery disease applying the SYNTAX Score ii in the heart team discussion of the SYNTAX ii trial
Catheterization and Cardiovascular Interventions, 2015Co-Authors: Carlos M Campos, Vasim Farooq, Yoshinobu Onuma, Hector M Garciagarcia, Bojan Stanetic, Yuki Ishibashi, Simon J Walsh, Javier Escaned, Adrian P BanningAbstract:textabstractBackground Heart Team (HT) and the SYNTAX Score II (SSII) have been integrated to the contemporary guidelines with the aim to provide a multidisciplinary decision-making process between coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI). Aims To prospectively assess the agreement between the HT decision and the SSII recommendation regarding the revascularization strategy in patients with 3-vessel coronary artery disease (CAD) of the SYNTAX II trial. Methods The SSII predicts the 4-year mortality of an individual patient both after PCI and after CABG. Patients were treated by PCI when the SSII predicted a mortality risk favoring PCI or when risk predictions were equipoise between PCI and CABG. However, the HT could overrule the SSII and recommend either CABG or PCI. Results A total of 202 patients have been screened and 24 did not fulfill inclusion criteria. The median age was 67.0 (IQR 59.0-73.3), and 167 (82.7%) were male. The HT endorsed SSII treatment recommendation, for CABG or PCI, in 152 patients (85.4%). Three patients had preference for PCI, irrespective of the HT decision. The main reason for the HT to overrule the SSII and recommend CABG was the prospect of a more complete revascularization (21 of 25 patients). Patients recommended for CABG by the HT had significantly higher anatomical SYNTAX Score (P = 0.03) and higher predicted mortality risk for PCI (P = 0.04) when compared with patients that were enrolled in the trial. Conclusion The SYNTAX Score II showed to be a suitable tool for guiding treatment decisions of patients with 3-vessel coronary artery disease being endorsed by the HT in the vast majority of the patients that have been enrolled in the SYNTAX II trial.
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long term forecasting and comparison of mortality in the evaluation of the xience everolimus eluting stent vs coronary artery bypass surgery for effectiveness of left main revascularization excel trial prospective validation of the SYNTAX Score ii
European Heart Journal, 2015Co-Authors: David Van Klaveren, Arie Pieter Kappetein, Carlos M Campos, Joseph F Sabik, Ewout W Steyerberg, Vasim Farooq, Charles A Simonton, Gregg W StoneAbstract:Aims To prospectively validate the SYNTAX Score II and forecast the outcomes of the randomized Evaluation of the Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) Trial. Methods and results Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization is a prospective, randomized multicenter trial designed to establish the efficacy and safety of percutaneous coronary intervention (PCI) with the everolimus-eluting stent compared with coronary artery bypass graft (CABG) surgery in subjects with unprotected left-main coronary artery (ULMCA) disease and low-intermediate anatomical SYNTAX Scores (<33). After completion of patient recruitment in EXCEL, the SYNTAX Score II was prospectively applied to predict 4-year mortality in the CABG and PCI arms. The 95% prediction intervals (PIs) for mortality were computed using simulation with bootstrap resampling (10 000 times). For the entire study cohort, the 4-year predicted mortalities were 8.5 and 10.5% in the PCI and CABG arms, respectively [odds ratios (OR) 0.79; 95% PI 0.43–1.50). In subjects with low (≤22) anatomical SYNTAX Scores, the predicted OR was 0.69 (95% PI 0.34–1.45); in intermediate anatomical SYNTAX Scores (23–32), the predicted OR was 0.93 (95% PI 0.53–1.62). Based on 4-year mortality predictions in EXCEL, clinical characteristics shifted long-term mortality predictions either in favour of PCI (older age, male gender and COPD) or CABG (younger age, lower creatinine clearance, female gender, reduced left ventricular ejection fraction). Conclusion The SYNTAX Score II indicates at least an equipoise for long-term mortality between CABG and PCI in subjects with ULMCA disease up to an intermediate anatomical complexity. Both anatomical and clinical characteristics had a clear impact on long-term mortality predictions and decision making between CABG and PCI.
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predictive performance of SYNTAX Score ii in patients with left main and multivessel coronary artery disease analysis of credo kyoto registry
Circulation, 2014Co-Authors: Carlos M Campos, Vasim Farooq, David Van Klaveren, Javaid Iqbal, Yoshinobu Onuma, Yaojun Zhang, Hector M Garciagarcia, Marieangele Morel, Hiroki ShiomiAbstract:Background:SYNTAX Score II (SSII) provides individualized estimates of 4-year mortality after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in order to facilitate decision-making between these revascularization methods. The purpose of the present study was to assess SSII in a real-world multicenter registry with distinct regional and epidemiological characteristics.Methods and Results:Long-term mortality was analyzed in 3,896 patients undergoing PCI (n=2,190) or CABG (n=1,796) from the Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/CABG registry cohort-2. SSII discriminated well in both CABG and PCI patient groups (concordance index [c-index], 0.70; 95% CI: 0.68–0.72; and 0.75, 95% CI: 0.72–0.78) surpassing anatomical SYNTAX Score (SS; c-index, 0.50; 95% CI: 0.47–0.53; and 0.59, 95% CI: 0.57–0.61). SSII had the best discriminative ability to separate low-, medium- and high-risk tertiles, and calibration plots showed good predictive performance for CABG and PCI groups. Use of anatomical SS as a reference improved the overall reclassification provided by SSII, with a net reclassification index of 0.5 (P<0.01).Conclusions:SSII has robust prognostic accuracy, both in CABG and in PCI patient groups and, compared with the anatomical SS alone, was more accurate in stratifying patients for late mortality in a real-world complex coronary artery disease Eastern population. (Circ J 2014; 78: 1942–1949)
Carlos M Campos - One of the best experts on this subject based on the ideXlab platform.
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appropriateness of myocardial revascularization assessed by the SYNTAX Score ii in a country without cardiac surgery facilities proust study
International Journal of Cardiology, 2017Co-Authors: Bojan Stanetic, Carlos M Campos, Vasim Farooq, Miodrag Ostojic, Kurt Huber, Tamara Kovacevicpreradovic, Jelena Marinkovic, Patrick W SerruysAbstract:Abstract Background/objectives The SYNTAX Score II (SSII) was proposed as a novel approach for objective individualized decision-making for optimal myocardial revascularization i.e. percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. We sought to investigate how many lives may be saved by SSII use. Methods A total number of 651 consecutive SSII-naive-patients with complex coronary artery disease who were treated with PCI (n=409) or referred to other institutions for CABG (n=242) were included. All-cause mortality was ascertained in 96% of patients. The SSII was calculated for each patient. Results Based on the SSII treatment recommendation, CABG would have been the treatment of choice in 257/651 (39.5%) patients, PCI in 7/651 (1.1%) patients and CABG or PCI in 387/651 (59.4%) patients. Out of 257 patients in whom the treatment recommendation by SSII was CABG, 113/257 (44.0%) patients had actually CABG, while the remaining 144/257 (56.0%) underwent PCI. It was shown that 144/257 patients with treatment recommendations in favour of CABG who were treated with PCI had significantly higher mortality at 4years when compared with patients with SSII treatment recommendation for PCI or equally favouring CABG and PCI (12.5% vs. 0.0% vs. 6.9%, respectively, P=0.04). Conclusion The intuitive decision-making for choosing the optimal myocardial revascularization method differed predominantly from the SSII recommendation for CABG. The discordance between the SSII recommended revascularization strategy and the clinical decision was associated with a higher 4-year mortality i.e. one life may be saved if SSII would be calculated and followed consequently in 18 patients.
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risk stratification in 3 vessel coronary artery disease applying the SYNTAX Score ii in the heart team discussion of the SYNTAX ii trial
Catheterization and Cardiovascular Interventions, 2015Co-Authors: Carlos M Campos, Vasim Farooq, Yoshinobu Onuma, Hector M Garciagarcia, Bojan Stanetic, Yuki Ishibashi, Simon J Walsh, Javier Escaned, Adrian P BanningAbstract:Background Heart Team (HT) and the SYNTAX Score II (SSII) have been integrated to the contemporary guidelines with the aim to provide a multidisciplinary decision-making process between coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI). Aims To prospectively assess the agreement between the HT decision and the SSII recommendation regarding the revascularization strategy in patients with 3-vessel coronary artery disease (CAD) of the SYNTAX II trial. Methods The SSII predicts the 4-year mortality of an individual patient both after PCI and after CABG. Patients were treated by PCI when the SSII predicted a mortality risk favoring PCI or when risk predictions were equipoise between PCI and CABG. However, the HT could overrule the SSII and recommend either CABG or PCI. Results A total of 202 patients have been screened and 24 did not fulfill inclusion criteria. The median age was 67.0 (IQR 59.0-73.3), and 167 (82.7%) were male. The HT endorsed SSII treatment recommendation, for CABG or PCI, in 152 patients (85.4%). Three patients had preference for PCI, irrespective of the HT decision. The main reason for the HT to overrule the SSII and recommend CABG was the prospect of a more complete revascularization (21 of 25 patients). Patients recommended for CABG by the HT had significantly higher anatomical SYNTAX Score (P = 0.03) and higher predicted mortality risk for PCI (P = 0.04) when compared with patients that were enrolled in the trial. Conclusion The SYNTAX Score II showed to be a suitable tool for guiding treatment decisions of patients with 3-vessel coronary artery disease being endorsed by the HT in the vast majority of the patients that have been enrolled in the SYNTAX II trial.
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risk stratification in 3 vessel coronary artery disease applying the SYNTAX Score ii in the heart team discussion of the SYNTAX ii trial
Catheterization and Cardiovascular Interventions, 2015Co-Authors: Carlos M Campos, Vasim Farooq, Yoshinobu Onuma, Hector M Garciagarcia, Bojan Stanetic, Yuki Ishibashi, Simon J Walsh, Javier Escaned, Adrian P BanningAbstract:textabstractBackground Heart Team (HT) and the SYNTAX Score II (SSII) have been integrated to the contemporary guidelines with the aim to provide a multidisciplinary decision-making process between coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI). Aims To prospectively assess the agreement between the HT decision and the SSII recommendation regarding the revascularization strategy in patients with 3-vessel coronary artery disease (CAD) of the SYNTAX II trial. Methods The SSII predicts the 4-year mortality of an individual patient both after PCI and after CABG. Patients were treated by PCI when the SSII predicted a mortality risk favoring PCI or when risk predictions were equipoise between PCI and CABG. However, the HT could overrule the SSII and recommend either CABG or PCI. Results A total of 202 patients have been screened and 24 did not fulfill inclusion criteria. The median age was 67.0 (IQR 59.0-73.3), and 167 (82.7%) were male. The HT endorsed SSII treatment recommendation, for CABG or PCI, in 152 patients (85.4%). Three patients had preference for PCI, irrespective of the HT decision. The main reason for the HT to overrule the SSII and recommend CABG was the prospect of a more complete revascularization (21 of 25 patients). Patients recommended for CABG by the HT had significantly higher anatomical SYNTAX Score (P = 0.03) and higher predicted mortality risk for PCI (P = 0.04) when compared with patients that were enrolled in the trial. Conclusion The SYNTAX Score II showed to be a suitable tool for guiding treatment decisions of patients with 3-vessel coronary artery disease being endorsed by the HT in the vast majority of the patients that have been enrolled in the SYNTAX II trial.
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long term forecasting and comparison of mortality in the evaluation of the xience everolimus eluting stent vs coronary artery bypass surgery for effectiveness of left main revascularization excel trial prospective validation of the SYNTAX Score ii
European Heart Journal, 2015Co-Authors: David Van Klaveren, Arie Pieter Kappetein, Carlos M Campos, Joseph F Sabik, Ewout W Steyerberg, Vasim Farooq, Charles A Simonton, Gregg W StoneAbstract:Aims To prospectively validate the SYNTAX Score II and forecast the outcomes of the randomized Evaluation of the Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) Trial. Methods and results Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization is a prospective, randomized multicenter trial designed to establish the efficacy and safety of percutaneous coronary intervention (PCI) with the everolimus-eluting stent compared with coronary artery bypass graft (CABG) surgery in subjects with unprotected left-main coronary artery (ULMCA) disease and low-intermediate anatomical SYNTAX Scores (<33). After completion of patient recruitment in EXCEL, the SYNTAX Score II was prospectively applied to predict 4-year mortality in the CABG and PCI arms. The 95% prediction intervals (PIs) for mortality were computed using simulation with bootstrap resampling (10 000 times). For the entire study cohort, the 4-year predicted mortalities were 8.5 and 10.5% in the PCI and CABG arms, respectively [odds ratios (OR) 0.79; 95% PI 0.43–1.50). In subjects with low (≤22) anatomical SYNTAX Scores, the predicted OR was 0.69 (95% PI 0.34–1.45); in intermediate anatomical SYNTAX Scores (23–32), the predicted OR was 0.93 (95% PI 0.53–1.62). Based on 4-year mortality predictions in EXCEL, clinical characteristics shifted long-term mortality predictions either in favour of PCI (older age, male gender and COPD) or CABG (younger age, lower creatinine clearance, female gender, reduced left ventricular ejection fraction). Conclusion The SYNTAX Score II indicates at least an equipoise for long-term mortality between CABG and PCI in subjects with ULMCA disease up to an intermediate anatomical complexity. Both anatomical and clinical characteristics had a clear impact on long-term mortality predictions and decision making between CABG and PCI.
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validity of SYNTAX Score ii for risk stratification of percutaneous coronary interventions a patient level pooled analysis of 5433 patients enrolled in contemporary coronary stent trials
International Journal of Cardiology, 2015Co-Authors: Carlos M Campos, David Van Klaveren, Hector M Garciagarcia, Lorenz Raber, Marco Valgimigli, Yuki Ishibashi, Yunkyeong Cho, Hans Jonker, Yoshinobu OnumaAbstract:Abstract Objectives To assess the clinical profile and long-term mortality in SYNTAX Score II based strata of patients who received percutaneous coronary interventions (PCI) in contemporary randomized trials. Background The SYNTAX Score II was developed in the randomized, all-comers' SYNTAX trial population and is composed by 2 anatomical and 6 clinical variables. The interaction of these variables with the treatment provides individual long-term mortality predictions if a patient undergoes coronary artery bypass grafting (CABG) or PCI. Methods Patient-level (n=5433) data from 7 contemporary coronary drug-eluting stent (DES) trials were pooled. The mortality for CABG or PCI was estimated for every patient. The difference in mortality estimates for these two revascularization strategies was used to divide the patients into three groups of theoretical treatment recommendations: PCI, CABG or PCI/CABG (the latter means equipoise between CABG and PCI for long term mortality). Results The three groups had marked differences in their baseline characteristics. According to the predicted risk differences, 5115 patients could be treated either by PCI or CABG, 271 should be treated only by PCI and, rarely, CABG (n=47) was recommended. At 3-year follow-up, according to the SYNTAX Score II recommendations, patients recommended for CABG had higher mortality compared to the PCI and PCI/CABG groups (17.4%; 6.1% and 5.3%, respectively; P Conclusions The SYNTAX Score II demonstrated capability to help in stratifying PCI procedures.
Yoshinobu Onuma - One of the best experts on this subject based on the ideXlab platform.
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external validation of the SYNTAX Score ii 2020
Journal of the American College of Cardiology, 2021Co-Authors: Hironori Hara, Ewout W Steyerberg, David Van Klaveren, Yoshinobu Onuma, Hiroki Shiomi, Patrick W Serruys, Scot Garg, David M Kent, Takeshi KimuraAbstract:Abstract Background The SYNTAX Score II 2020 (SSII-2020) was derived from cross correlation and externally validated in randomized trials to predict death and major adverse cardiac and cerebrovascular events (MACE) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with 3-vessel disease (3VD) and/or left main coronary artery disease (LMCAD). Objectives The authors aimed to investigate the SSII-2020’s value in identifying the safest modality of revascularization in a non-randomized setting. Methods Five-year mortality and MACE were assessed in 7,362 patients with 3VD and/or LMCAD enrolled in a Japanese PCI/CABG registry. The discriminative abilities of the SSII-2020 were assessed using Harrell’s C statistic. Agreement between observed and predicted event rates following PCI or CABG and treatment benefit (absolute risk difference [ARD]) for these outcomes were assessed by calibration plots. Results The SSII-2020 for 5-year mortality well predicted the prognosis after PCI and CABG (C-index = 0.72, intercept = −0.11, slope = 0.92). When patients were grouped according to the predicted 5-year mortality ARD, Conclusions The SSII-2020 for predicting 5-year death has the potential to support decision making on revascularization in patients with 3VD and/or LMCAD.
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tct 239 impact of nonrespect of SYNTAX Score ii recommendations for surgery in patients with complex coronary artery disease treated by pci a pooled analysis of 3 280 randomized patients SYNTAX best and precombat trials
Journal of the American College of Cardiology, 2019Co-Authors: Patrick W Serruys, Yoshinobu Onuma, Kuniaki Takahashi, Ply Chichareon, Rodrigo Modolo, Norihiro Kogame, Chun Chin Chang, Mariusz Tomaniak, Jungmin Ahn, Seungjung ParkAbstract:The SYNTAX Score II (SSII) was developed to predict 4-year all-cause mortality after left main (LM) or multivessel disease revascularization and to facilitate the decision-making process by providing the following treatment recommendations: 1) coronary artery bypass grafting (CABG) or percutaneous
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validation of the updated logistic clinical SYNTAX Score for all cause mortality in the global leaders trial
Eurointervention, 2019Co-Authors: Ply Chichareon, David Van Klaveren, Yoshinobu Onuma, Taku Asano, Kuniaki Takahashi, Rodrigo Modolo, Norihiro Kogame, Chun Chin Chang, Mariusz Tomaniak, Yuki KatagiriAbstract:Aims: The aim of this study was the external validation of the updated logistic clinical SYNTAX Score for two-year all-cause mortality after PCI in the GLOBAL LEADERS trial. Methods and results: The GLOBAL LEADERS trial was an investigator-initiated, prospective randomised, multicentre, open-label trial comparing two strategies of antiplatelet therapy in 15,991 patients undergoing PCI. As a predefined analysis, we studied the first 4,006 consecutive patients enrolled between July 2013 and April 2014 for whom the anatomic SYNTAX Scores were calculated by an independent core lab. The updated logistic clinical SYNTAX Score was available in 3,271 patients. Patients were divided into quintiles according to the Score. The C-statistic of the updated logistic clinical SYNTAX Score for twoyear all-cause mortality was 0.71 (95% confidence interval [CI]: 0.64-0.77). The updated logistic clinical SYNTAX Score identified patients at very high risk for two-year all-cause mortality after PCI. Although it systematically overestimated two-year all-cause mortality, predicted and observed two-year all-cause mortality in the majority of the patients (four out of five quintiles) were in agreement. Conclusions: Overall discrimination for two-year all-cause mortality of the updated logistic clinical SYNTAX Score is either borderline acceptable or possibly helpful. Calibration in the majority of patients is appropriate. The Score is potentially useful in selecting enriched high-risk populations.
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tct 221 treatment recommendations based on SYNTAX Score ii and observed 3 year mortality in the excel trial
Journal of the American College of Cardiology, 2017Co-Authors: Patrick W Serruys, Yoshinobu Onuma, Marieangele Morel, Philippe Genereux, Ovidiu Dressler, Carlos Collet, Marie Claude Morice, Yiran Zhang, Martin B Leon, David E KandzariAbstract:The SYNTAX Score II (SSII) risk Score was developed from the SYNTAX trial to predict 4-year mortality after left main (LM) or multivessel disease revascularization. SSII combines anatomic lesion data and selected clinical characteristics (age, sex, COPD, peripheral artery disease, LVEF, creatinine
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integration of non invasive functional assessments with anatomical risk stratification in complex coronary artery disease the non invasive functional SYNTAX Score
Cardiovascular diagnosis and therapy, 2017Co-Authors: Carlos Collet, Yoshinobu Onuma, Marieangele Morel, Yosuke Miyazaki, Patrick W SerruysAbstract:Since the early days of coronary angiography, the extension and severity of coronary artery disease (CAD) have been used for risk stratification. The SYNTAX Score objectively characterizes CAD in patients with multivessel disease. Furthermore, recalculating the SYNTAX Score by the incorporation of the functional component coronary stenosis (i.e., FFR) increases the discrimination for the risk of adverse events. The calculation of the SYNTAX Score derived from non-invasive modalities such as coronary computed tomography angiography (CTA) has emerged as a mean to obtain the SYNTAX Score before invasive cardiac catheterization. Likewise, the computation of the non-invasive fractional flow reserve CT (FFRCT) allows for the calculation of the non-invasive functional SYNTAX Score. Ultimately, the combination of anatomical and functional evaluations with clinical factors further refines the identification of patients at risk and provides a recommendation for the Heart Team regarding the treatment strategy (i.e., PCI or CABG) based on the predicted 4-year mortality. The purpose of this review is to describe the integration of a novel non-invasive functional coronary assessment with the angiographic risk Score in patients with multivessel CAD.
Kuniaki Takahashi - One of the best experts on this subject based on the ideXlab platform.
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usefulness of updated logistic clinical SYNTAX Score based on mi SYNTAX Score in patients with st elevation myocardial infarction
Catheterization and Cardiovascular Interventions, 2021Co-Authors: Hideyuki Kawashima, Hironori Hara, Rutao Wang, Masafumi Ono, Chao Gao, Kuniaki Takahashi, Harry SuryapranataAbstract:Objectives To compare the predictive performances of the prewiring, postwiring MI-SYNTAX Scores, prewiring, and postwiring Updated Logistic Clinical SYNTAX Score (LCSS) for 2-year all-cause mortality post percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients. Background In patients with STEMI and undergoing primary PCI, coronary stenosis(es) distal to the culprit lesion is often observed after the restoration of coronary flow. To address comprehensively the complex coronary anatomy in these patients, prewiring and postwiring MI-SYNTAX Scores have been reported in the literature. Furthermore, to enable individualized risk estimation for long-term all-cause mortality, the Updated LCSS has been developed by combining the anatomical SYNTAX Score and clinical factors. Methods In the randomized GLOBAL LEADERS trial, anatomical SYNTAX Score analysis was performed by an independent angiographic corelab for the first 4,000 consecutive patients as a prespecified analysis; of these, 545 presented with STEMI. The efficacy of the mortality predictions of the four Scores at 2 years were evaluated based on their discrimination and calibration abilities. Results Complete data was available in 512 patients (93.9%). When the patients were stratified into two groups based on the median of the Scores, the prewiring and postwiring Updated LCSSs demonstrated that the high-Score groups were associated with higher rates of 2-year all-cause mortality compared to the low-Score groups (6.6 vs. 1.2%; log-rank p = .001 and 6.6 vs. 1.2%; log-rank p = .001, respectively). There were no statistically significant differences for predicting the mortality between the prewiring (area under the curve [AUC] 0.625), postwiring MI-SYNTAX Score (AUC 0.614), prewiring (AUC 0.755), and postwiring Updated LCSS (AUC 0.757). In the integrated discrimination improvement (IDI), the prewiring MI-SYNTAX Score had a better discrimination for the mortality than the postwiring MI-SYNTAX Score (IDI -0.0082; p = .029). The four Scores had acceptable calibration abilities for 2-year all-cause mortality. Conclusions The prewiring Updated LCSS predicts long-term all-cause mortality with clearly useful discrimination and acceptable calibration. Since the postwiring MI-SYNTAX Score does not improve mortality prediction, the prewiring MI-SYNTAX Score may be preferred for the 2-year mortality prediction using the Updated LCSS.
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predicting 2 year all cause mortality after contemporary pci updating the logistic clinical SYNTAX Score
Catheterization and Cardiovascular Interventions, 2021Co-Authors: David Van Klaveren, Kuniaki Takahashi, Ply Chichareon, Rodrigo Modolo, Norihiro Kogame, Chun Chin Chang, Mariusz TomaniakAbstract:Aims We aimed to update the logistic clinical SYNTAX Score to predict 2 year all-cause mortality after contemporary percutaneous coronary intervention (PCI). Methods and results We analyzed 15,883 patients in the GLOBAL LEADERS study who underwent PCI. The logistic clinical SYNTAX model was updated after imputing missing values by refitting the original model (refitted original model) and fitting an extended new model (new model, with, selection based on the Akaike Information Criterion). External validation was performed in 10,100 patients having PCI at Fu Wai hospital. Chronic obstructive pulmonary disease, prior stroke, current smoker, hemoglobin level, and white blood cell count were identified as additional independent predictors of 2 year all-cause mortality and included into the new model. The c-indexes of the original, refitted original and the new model in the derivation cohort were 0.74 (95% CI 0.72-0.76), 0.75 (95% CI 0.73-0.77), and 0.78 (95% CI 0.76-0.80), respectively. The c-index of the new model was lower in the validation cohort than in the derivation cohort, but still showed improved discriminative ability of the newly developed model (0.72; 95% CI 0.67-0.77) compared to the refitted original model (0.69; 95% CI 0.64-0.74). The models overestimated the observed 2 year all-cause mortality of 1.11% in the Chinese external validation cohort by 0.54 percentage points, indicating the need for calibration of the model to the Chinese patient population. Conclusions The new model of the logistic clinical SYNTAX Score better predicts 2 year all-cause mortality after PCI than the original model. The new model could guide clinical decision making by risk stratifying patients undergoing PCI.
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redevelopment and validation of the SYNTAX Score ii to individualise decision making between percutaneous and surgical revascularisation in patients with complex coronary artery disease secondary analysis of the multicentre randomised controlled SYNTAXes trial with external cohort validation
The Lancet, 2020Co-Authors: Kuniaki Takahashi, Patrick W Serruys, Michael E Farkouh, Valentin Fuster, Seungjung Park, John A Spertus, David J Cohen, Dukwoo Park, Jungmin AhnAbstract:Summary Background Randomised controlled trials are considered the gold standard for testing the efficacy of novel therapeutic interventions, and typically report the average treatment effect as a summary result. As the result of treatment can vary between patients, basing treatment decisions for individual patients on the overall average treatment effect could be suboptimal. We aimed to develop an individualised decision making tool to select an optimal revascularisation strategy in patients with complex coronary artery disease. Methods The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries between March, 2005, and April, 2007. Patients with de-novo three-vessel and left main coronary artery disease were randomly assigned (1:1) to either the percutaneous coronary intervention (PCI) group or coronary artery bypass grafting (CABG) group. The SYNTAXES study ascertained 10-year all-cause deaths. We used Cox regression to develop a clinical prognostic index for predicting death over a 10-year period, which was combined, in a second stage, with assigned treatment (PCI or CABG) and two prespecified effect-modifiers, which were selected on the basis of previous evidence: disease type (three-vessel disease or left main coronary artery disease) and anatomical SYNTAX Score. We used similar techniques to develop a model to predict the 5-year risk of major adverse cardiovascular events (defined as a composite of all-cause death, non-fatal stroke, or non-fatal myocardial infarction) in patients receiving PCI or CABG. We then assessed the ability of these models to predict the risk of death or a major adverse cardiovascular event, and their differences (ie, the estimated benefit of CABG versus PCI by calculating the absolute risk difference between the two strategies) by cross-validation with the SYNTAX trial (n=1800 participants) and external validation in the pooled population (n=3380 participants) of the FREEDOM, BEST, and PRECOMBAT trials. The concordance (C)-index was used to measure discriminative ability, and calibration plots were used to assess the degree of agreement between predictions and observations. Findings At cross-validation, the newly developed SYNTAX Score II, termed SYNTAX Score II 2020, showed a helpful discriminative ability in both treatment groups for predicting 10-year all-cause deaths (C-index=0·73 [95% CI 0·69–0·76] for PCI and 0·73 [0·69–0·76] for CABG) and 5-year major adverse cardiovascular events (C-index=0·65 [0·61–0·69] for PCI and C-index=0·71 [0·67–0·75] for CABG). At external validation, the SYNTAX Score II 2020 showed helpful discrimination (C-index=0·67 [0·63–0·70] for PCI and C-index=0·62 [0·58–0·66] for CABG) and good calibration for predicting 5-year major adverse cardiovascular events. The estimated treatment benefit of CABG over PCI varied substantially among patients in the trial population, and the benefit predictions were well calibrated. Interpretation The SYNTAX Score II 2020 for predicting 10-year deaths and 5-year major adverse cardiovascular events can help to identify individuals who will benefit from either CABG or PCI, thereby supporting heart teams, patients, and their families to select optimal revascularisation strategies. Funding The German Heart Research Foundation and the Patient-Centered Outcomes Research Institute.
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usefulness of the updated logistic clinical SYNTAX Score after percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery insights from the global leaders trial
Catheterization and Cardiovascular Interventions, 2020Co-Authors: Hironori Hara, Masafumi Ono, Kuniaki Takahashi, Ply Chichareon, Rodrigo Modolo, Norihiro Kogame, Mariusz Tomaniak, Hideyuki KawashimaAbstract:Objectives: We aimed to investigate the prognostic utility of the anatomical CABG SYNTAX and logistic clinical SYNTAX Scores for mortality after percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafts (CABG). Background: The anatomical SYNTAX Score evaluated the anatomical complexity of coronary artery disease and helped predict the prognosis of patients undergoing PCI. The anatomical CABG SYNTAX Score was derived from the anatomical SYNTAX Score in patients with prior CABG, whilst the logistic clinical SYNTAX Score was developed by incorporating clinical factors into the anatomical SYNTAX Score. Methods: We calculated the anatomical CABG SYNTAX Score and logistic clinical SYNTAX Score in 205 patients in the GLOBAL LEADERS trial. The predictive abilities of these Scores for 2-year all-cause mortality were evaluated. Results: Using the median Scores as categorical thresholds between low and high Score groups, the logistic clinical SYNTAX Score was able to discriminate the risk of 2-year mortality, unlike the anatomical CABG SYNTAX Score. The logistic clinical SYNTAX was significantly better at predicting 2-year mortality, compared to the anatomical CABG SYNTAX Score, as evidenced by AUC values in receiver-operating characteristic curve analysis (0.806 vs. 0.582, p <.001) and integrated discrimination improvement (0.121, p <.001). Conclusions: The logistic clinical SYNTAX Score was superior to the anatomical CABG SYNTAX Score in predicting 2-year mortality.
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tct 239 impact of nonrespect of SYNTAX Score ii recommendations for surgery in patients with complex coronary artery disease treated by pci a pooled analysis of 3 280 randomized patients SYNTAX best and precombat trials
Journal of the American College of Cardiology, 2019Co-Authors: Patrick W Serruys, Yoshinobu Onuma, Kuniaki Takahashi, Ply Chichareon, Rodrigo Modolo, Norihiro Kogame, Chun Chin Chang, Mariusz Tomaniak, Jungmin Ahn, Seungjung ParkAbstract:The SYNTAX Score II (SSII) was developed to predict 4-year all-cause mortality after left main (LM) or multivessel disease revascularization and to facilitate the decision-making process by providing the following treatment recommendations: 1) coronary artery bypass grafting (CABG) or percutaneous
