The Experts below are selected from a list of 202812 Experts worldwide ranked by ideXlab platform
Patrick W Serruys - One of the best experts on this subject based on the ideXlab platform.
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clinical outcomes of state of the art percutaneous coronary revascularisation in patients with three vessel disease two year follow up of the Syntax ii study
Eurointervention, 2019Co-Authors: Patrick W Serruys, Rodrigo Modolo, Norihiro Kogame, Yuki Katagiri, Pawel Buszman, Andres Iniguezromo, Javier Goicolea, David Hildicksmith, Andrzej Ochala, Dariusz DudekAbstract:Aims: The purpose of the study was to investigate whether the favourable outcomes of state-of-the-art PCI in the Syntax II trial, demonstrated at one year, were maintained at two-year follow-up. Methods and results: The Syntax II study was a multicentre, single-arm study that investigated the impact of a contemporary PCI strategy on clinical outcomes in 454 patients with de novo three-vessel coronary artery disease, without left main disease. Clinical outcomes in Syntax II were compared to the predefined PCI (Syntax-I PCI) and coronary artery bypass graft (Syntax-I CABG) cohorts from the landmark Syntax trial (Syntax-I), selected on the basis of equipoise for long-term (four-year) mortality utilising the Syntax score II. At two years, major adverse cardiac and cerebrovascular events (MACCE: a composite of all-cause death, any stroke, myocardial infarction, or revascularisation) in Syntax II were significantly lower compared to Syntax-I PCI (13.2% vs. 21.9%, p=0.001). Furthermore, similar twoyear outcomes for MACCE were evident between Syntax II PCI and Syntax-I CABG (13.2% vs. 15.1%, p=0.42). Conclusions: At two years, clinical outcomes with the Syntax II strategy remained superior to the predefined Syntax-I PCI cohort, and similar to the predefined Syntax-I CABG cohort.
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response to letter regarding article quantification of incomplete revascularization and its association with five year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery Syntax trial validation of the r
Circulation, 2014Co-Authors: Vasim Farooq, Yaojun Zhang, Patrick W Serruys, Christos V Bourantas, David R Holmes, Michael J Mack, Takashi Muramatsu, Ted Feldman, Marie Claude Morice, Elisabeth StahleAbstract:We thank Carnero-Alcazar and colleagues for their comments concerning our article.1 First, the readership should be reminded that the anatomic Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (Syntax) score was designed before the Syntax trial as a tool to force the interventional cardiologist and cardiac surgeon to systematically analyze the coronary angiogram and agree that “equivalent anatomic revascularization” could be achieved on the basis of a vessel size of 1.5 mm. A vessel size of 1.5 mm was selected as this was the size of the vessel the cardiac surgeon stated they could revascularize. Before the Syntax trial, the Syntax score was tested in the Arterial Revascularization Therapies Study (ARTS) II Study.2 In the Syntax trial protocol, outcomes related to the Syntax score were prespecified. Since the Syntax trial, numerous studies have validated the Syntax score.3 Second, criticisms related to the reproducibility of the Syntax score appear excessive. The simple interpretation of a coronary angiogram, on which most contemporary …
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widening clinical applications of the Syntax score
Heart, 2014Co-Authors: Vasim Farooq, Arie Pieter Kappetein, Stuart J Head, Patrick W SerruysAbstract:The Syntax Score (http://www.Syntaxscore.com) has established itself as an anatomical based tool for objectively determining the complexity of coronary artery disease and guiding decision-making between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). Since the landmark Syntax (Synergy between PCI with Taxus and Cardiac Surgery) Trial comparing CABG with PCI in patients with complex coronary artery disease (unprotected left main or de novo three vessel disease), numerous validation studies have confirmed the clinical validity of the Syntax Score for identifying higher-risk subjects and aiding decision-making between CABG and PCI in a broad range of patient types. The Syntax Score is now advocated in both the European and US revascularisation guidelines for decision-making between CABG and PCI as part of a Syntax-pioneered heart team approach. Since establishment of the Syntax Score, widening clinical applications of this clinical tool have emerged. The purpose of this review is to systematically examine the widening applications of tools based on the Syntax Score: (1) by improving the diagnostic accuracy of the Syntax Score by adding a functional assessment of lesions; (2) through amalgamation of the anatomical Syntax Score with clinical variables to enhance decision-making between CABG and PCI, culminating in the development and validation of the Syntax Score II, in which objective and tailored decisions can be made for the individual patient; (3) through assessment of completeness of revascularisation using the residual and post-CABG Syntax Scores for PCI and CABG patients, respectively. Finally, the future direction of the Syntax Score is covered through discussion of the ongoing development of a non-invasive, functional Syntax Score and review of current and planned clinical trials.
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quantification of incomplete revascularization and its association with five year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery Syntax trial validation of the residual Syntax score
Circulation, 2013Co-Authors: Vasim Farooq, Yaojun Zhang, Patrick W Serruys, Christos V Bourantas, David R Holmes, Michael J Mack, Takashi Muramatsu, Ted Feldman, Marie Claude Morice, Elisabeth StahleAbstract:Background—The residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (Syntax) Score is an objective measure of the degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). Methods and Results—In the randomized PCI cohort of the Syntax Trial (n=903), the baseline and residual Syntax Scores were calculated. Subjects with a residual Syntax Score of 0 were defined as having undergone complete revascularization (CR), and a residual Syntax Score >0 as incomplete revascularization (ICR). Five-year clinical outcomes were stratified by CR and ICR (tertiles of the residual Syntax Score: >0–4, >4–8, and >8). In the PCI cohort, the mean baseline and residual Syntax Scores were 28.4±11.5 and 4.5±6.9, respectively. The mean Δ Syntax Score (representative of the burden of disease removed by PCI) was 23.8±10.9. The residual Syntax Score was distributed as follows: CR, 0 (n=386, 42.7%); ICR, >0 to 4 (n=184, 20.4%), >4 to 8 (n=167, 18.5%), >8 (n=153, 16...
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the Syntax score and Syntax based clinical risk scores
Seminars in Thoracic and Cardiovascular Surgery, 2011Co-Authors: Vasim Farooq, Salvatore Brugaletta, Patrick W SerruysAbstract:Risk stratification is an important and essential component in appropriately informing patients electing to undergo coronary artery bypass graft or percutaneous coronary intervention. This process is an integral part of the Syntax pioneered Heart Team approach in selecting the most appropriate revascularization modality in patients with complex coronary artery disease. The Syntax score was pioneered as an anatomical-based risk score that aided in this decision-making process. The purpose of this review is to examine the Syntax score and subsequent risk models that have been developed on the basis of this landmark anatomical-based risk score.
Michael J Mack - One of the best experts on this subject based on the ideXlab platform.
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response to letter regarding article quantification of incomplete revascularization and its association with five year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery Syntax trial validation of the r
Circulation, 2014Co-Authors: Vasim Farooq, Yaojun Zhang, Patrick W Serruys, Christos V Bourantas, David R Holmes, Michael J Mack, Takashi Muramatsu, Ted Feldman, Marie Claude Morice, Elisabeth StahleAbstract:We thank Carnero-Alcazar and colleagues for their comments concerning our article.1 First, the readership should be reminded that the anatomic Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (Syntax) score was designed before the Syntax trial as a tool to force the interventional cardiologist and cardiac surgeon to systematically analyze the coronary angiogram and agree that “equivalent anatomic revascularization” could be achieved on the basis of a vessel size of 1.5 mm. A vessel size of 1.5 mm was selected as this was the size of the vessel the cardiac surgeon stated they could revascularize. Before the Syntax trial, the Syntax score was tested in the Arterial Revascularization Therapies Study (ARTS) II Study.2 In the Syntax trial protocol, outcomes related to the Syntax score were prespecified. Since the Syntax trial, numerous studies have validated the Syntax score.3 Second, criticisms related to the reproducibility of the Syntax score appear excessive. The simple interpretation of a coronary angiogram, on which most contemporary …
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quantification of incomplete revascularization and its association with five year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery Syntax trial validation of the residual Syntax score
Circulation, 2013Co-Authors: Vasim Farooq, Yaojun Zhang, Patrick W Serruys, Christos V Bourantas, David R Holmes, Michael J Mack, Takashi Muramatsu, Ted Feldman, Marie Claude Morice, Elisabeth StahleAbstract:Background—The residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (Syntax) Score is an objective measure of the degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). Methods and Results—In the randomized PCI cohort of the Syntax Trial (n=903), the baseline and residual Syntax Scores were calculated. Subjects with a residual Syntax Score of 0 were defined as having undergone complete revascularization (CR), and a residual Syntax Score >0 as incomplete revascularization (ICR). Five-year clinical outcomes were stratified by CR and ICR (tertiles of the residual Syntax Score: >0–4, >4–8, and >8). In the PCI cohort, the mean baseline and residual Syntax Scores were 28.4±11.5 and 4.5±6.9, respectively. The mean Δ Syntax Score (representative of the burden of disease removed by PCI) was 23.8±10.9. The residual Syntax Score was distributed as follows: CR, 0 (n=386, 42.7%); ICR, >0 to 4 (n=184, 20.4%), >4 to 8 (n=167, 18.5%), >8 (n=153, 16...
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anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients development and validation of Syntax score ii
The Lancet, 2013Co-Authors: Vasim Farooq, Arie Pieter Kappetein, Ewout W Steyerberg, David Van Klaveren, Yvonne Vergouwe, Emanuele Meliga, Alaide Chieffo, Antonio Colombo, David R Holmes, Michael J MackAbstract:Summary Background The anatomical Syntax score is advocated in European and US guidelines as an instrument to help clinicians decide the optimum revascularisation method in patients with complex coronary artery disease. The absence of an individualised approach and of clinical variables to guide decision making between coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) are limitations of the Syntax score. Syntax score II aimed to overcome these limitations. Methods Syntax score II was developed by applying a Cox proportional hazards model to results of the randomised all comers Syntax trial (n=1800). Baseline features with strong associations to 4-year mortality in either the CABG or the PCI settings (interactions), or in both (predictive accuracy), were added to the anatomical Syntax score. Comparisons of 4-year mortality predictions between CABG and PCI were made for each patient. Discriminatory performance was quantified by concordance statistics and internally validated with bootstrap resampling. External validation was done in the multinational all comers DELTA registry (n=2891), a heterogeneous population that included patients with three-vessel disease (26%) or complex coronary artery disease (anatomical Syntax score ≥33, 30%) who underwent CABG or PCI. The Syntax trial is registered with ClinicalTrials.gov, number NCT00114972. Findings Syntax score II contained eight predictors: anatomical Syntax score, age, creatinine clearance, left ventricular ejection fraction (LVEF), presence of unprotected left main coronary artery (ULMCA) disease, peripheral vascular disease, female sex, and chronic obstructive pulmonary disease (COPD). Syntax score II significantly predicted a difference in 4-year mortality between patients undergoing CABG and those undergoing PCI (p interaction 0·0037). To achieve similar 4-year mortality after CABG or PCI, younger patients, women, and patients with reduced LVEF required lower anatomical Syntax scores, whereas older patients, patients with ULMCA disease, and those with COPD, required higher anatomical Syntax scores. Presence of diabetes was not important for decision making between CABG and PCI (p interaction 0·67). Syntax score II discriminated well in all patients who underwent CABG or PCI, with concordance indices for internal (Syntax trial) validation of 0·725 and for external (DELTA registry) validation of 0·716, which were substantially higher than for the anatomical Syntax score alone (concordance indices of 0·567 and 0·612, respectively). A nomogram was constructed that allowed for an accurate individualised prediction of 4-year mortality in patients proposing to undergo CABG or PCI. Interpretation Long-term (4-year) mortality in patients with complex coronary artery disease can be well predicted by a combination of anatomical and clinical factors in Syntax score II. Syntax score II can better guide decision making between CABG and PCI than the original anatomical Syntax score. Funding Boston Scientific Corporation.
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complex coronary anatomy in coronary artery bypass graft surgery impact of complex coronary anatomy in modern bypass surgery lessons learned from the Syntax trial after two years
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Friedrich W Mohr, Patrick W Serruys, David R Holmes, A Rastan, Pieter A Kappetein, Jose L Pomar, Stephen Westaby, Katrin Leadley, Keith D Dawkins, Michael J MackAbstract:Objective Syntax study compares outcomes of coronary artery bypass grafting with percutaneous coronary intervention in patients with 3-vessel and/or left main disease. Complexity of coronary artery disease was quantified by the Syntax score, which combines anatomic characteristics of each significant lesion. This study aims to clarify whether Syntax score affects the outcome of bypass grafting as defined by major adverse cerebrovascular and cardiac events (MACCE) and its components over a 2-year follow-up period. Methods Of the 3075 patients enrolled in Syntax, 1541 underwent coronary artery bypass grafting (897 randomized controlled trial patients, and 644 registry patients). All patients undergoing bypass grafting were stratified according to their Syntax score into 3 tertiles: low (0–22), intermediate (22–32), and high (≥33) complexity. Clinical outcomes up to 2 years after allocation were determined for each group and further risk factor analysis was performed. Results Registry patients had more complex disease than those in the randomized controlled trial (Syntax score: registry 37.8 ± 13.3 vs randomized 29.1 ± 11.4; P Syntax score did not significantly affect overall 2-year MACCE rate of 15.6% for low, 14.3% for medium, and 15.4% for high Syntax scores. Compared with randomized patients, registry patients had a lower rate of overall MACCE rate (registry 13.0% vs randomized 16.7%; P = .046) and repeat revascularization (4.7% vs 8.6%; P = .003), whereas other event rates were comparable. Risk factor analysis revealed left main disease ( P = .049) and incomplete revascularization ( P = .005) as predictive for adverse 2-year outcomes. Conclusions The outcome of coronary artery bypass grafting was excellent and independent from the Syntax score. Incomplete revascularization rather than degree of coronary complexity adversely affects late outcomes of coronary bypass.
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assessment of the Syntax score in the Syntax study
Eurointervention, 2009Co-Authors: Patrick W Serruys, Arie Pieter Kappetein, David R Holmes, Michael J Mack, Yoshinobu Onuma, Scot Garg, Giovanna Sarno, Marcel Van Den Brand, Nic Van Dyck, Ted FeldmanAbstract:Aims: The Syntax™ score has been designed to better anticipate the risks of percutaneous or surgical revascularisation, taking into account the functional impact of the coronary circulation with all its anatomic components including the presence of bifurcations, total occlusions, thrombus, calcification, and small vessels. The purpose of this paper is to describe the baseline assessment of the Syntax™ score in the Syntax randomised trial, the corelab reproducibility, the potential difference in score assessment between the investigator and the corelab, and to ascertain the impact on one-year outcome after either percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) in patients with complex coronary artery disease. Methods and results: To assess the reliability of Syntax™ scoring, 100 diagnostic angiograms from the Syntax trial were randomly selected and assessed independently by two observers. Intra-observer variability was assessed by analysing 91 sets of angiograms after an interval of at least eight weeks by one of the observers. Clinical outcomes in the randomised cohort of the Syntax trial up to one year are presented with stratification by tertile group of the Syntax™ score. The weighted kappa value for the inter-observer reproducibility on the global score was 0.45, while the intra-observer weighted kappa value was 0.59. The Syntax™ score as calculated by investigators consistently underscored the corelab score by 3.4 points. When the Syntax randomised cohort was stratified by tertiles of the Syntax™ score, there were similar or nonsignificantly different MACCE rates in those with low or intermediate scores; however in the top tertile the MACCE rate was greater in those receiving PCI compared to CABG. Conclusions: The Syntax™ score is a visual coronary score with an acceptable corelab reproducibility that has an impact on the one-year outcome of those having PCI, whereas it has no effect on the one-year outcome following surgical revascularisation. The Syntax™ score tool is likely to be useful in a wide range of patients with complex coronary disease.
Vasim Farooq - One of the best experts on this subject based on the ideXlab platform.
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response to letter regarding article quantification of incomplete revascularization and its association with five year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery Syntax trial validation of the r
Circulation, 2014Co-Authors: Vasim Farooq, Yaojun Zhang, Patrick W Serruys, Christos V Bourantas, David R Holmes, Michael J Mack, Takashi Muramatsu, Ted Feldman, Marie Claude Morice, Elisabeth StahleAbstract:We thank Carnero-Alcazar and colleagues for their comments concerning our article.1 First, the readership should be reminded that the anatomic Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (Syntax) score was designed before the Syntax trial as a tool to force the interventional cardiologist and cardiac surgeon to systematically analyze the coronary angiogram and agree that “equivalent anatomic revascularization” could be achieved on the basis of a vessel size of 1.5 mm. A vessel size of 1.5 mm was selected as this was the size of the vessel the cardiac surgeon stated they could revascularize. Before the Syntax trial, the Syntax score was tested in the Arterial Revascularization Therapies Study (ARTS) II Study.2 In the Syntax trial protocol, outcomes related to the Syntax score were prespecified. Since the Syntax trial, numerous studies have validated the Syntax score.3 Second, criticisms related to the reproducibility of the Syntax score appear excessive. The simple interpretation of a coronary angiogram, on which most contemporary …
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widening clinical applications of the Syntax score
Heart, 2014Co-Authors: Vasim Farooq, Arie Pieter Kappetein, Stuart J Head, Patrick W SerruysAbstract:The Syntax Score (http://www.Syntaxscore.com) has established itself as an anatomical based tool for objectively determining the complexity of coronary artery disease and guiding decision-making between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). Since the landmark Syntax (Synergy between PCI with Taxus and Cardiac Surgery) Trial comparing CABG with PCI in patients with complex coronary artery disease (unprotected left main or de novo three vessel disease), numerous validation studies have confirmed the clinical validity of the Syntax Score for identifying higher-risk subjects and aiding decision-making between CABG and PCI in a broad range of patient types. The Syntax Score is now advocated in both the European and US revascularisation guidelines for decision-making between CABG and PCI as part of a Syntax-pioneered heart team approach. Since establishment of the Syntax Score, widening clinical applications of this clinical tool have emerged. The purpose of this review is to systematically examine the widening applications of tools based on the Syntax Score: (1) by improving the diagnostic accuracy of the Syntax Score by adding a functional assessment of lesions; (2) through amalgamation of the anatomical Syntax Score with clinical variables to enhance decision-making between CABG and PCI, culminating in the development and validation of the Syntax Score II, in which objective and tailored decisions can be made for the individual patient; (3) through assessment of completeness of revascularisation using the residual and post-CABG Syntax Scores for PCI and CABG patients, respectively. Finally, the future direction of the Syntax Score is covered through discussion of the ongoing development of a non-invasive, functional Syntax Score and review of current and planned clinical trials.
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quantification of incomplete revascularization and its association with five year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery Syntax trial validation of the residual Syntax score
Circulation, 2013Co-Authors: Vasim Farooq, Yaojun Zhang, Patrick W Serruys, Christos V Bourantas, David R Holmes, Michael J Mack, Takashi Muramatsu, Ted Feldman, Marie Claude Morice, Elisabeth StahleAbstract:Background—The residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (Syntax) Score is an objective measure of the degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). Methods and Results—In the randomized PCI cohort of the Syntax Trial (n=903), the baseline and residual Syntax Scores were calculated. Subjects with a residual Syntax Score of 0 were defined as having undergone complete revascularization (CR), and a residual Syntax Score >0 as incomplete revascularization (ICR). Five-year clinical outcomes were stratified by CR and ICR (tertiles of the residual Syntax Score: >0–4, >4–8, and >8). In the PCI cohort, the mean baseline and residual Syntax Scores were 28.4±11.5 and 4.5±6.9, respectively. The mean Δ Syntax Score (representative of the burden of disease removed by PCI) was 23.8±10.9. The residual Syntax Score was distributed as follows: CR, 0 (n=386, 42.7%); ICR, >0 to 4 (n=184, 20.4%), >4 to 8 (n=167, 18.5%), >8 (n=153, 16...
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anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients development and validation of Syntax score ii
The Lancet, 2013Co-Authors: Vasim Farooq, Arie Pieter Kappetein, Ewout W Steyerberg, David Van Klaveren, Yvonne Vergouwe, Emanuele Meliga, Alaide Chieffo, Antonio Colombo, David R Holmes, Michael J MackAbstract:Summary Background The anatomical Syntax score is advocated in European and US guidelines as an instrument to help clinicians decide the optimum revascularisation method in patients with complex coronary artery disease. The absence of an individualised approach and of clinical variables to guide decision making between coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) are limitations of the Syntax score. Syntax score II aimed to overcome these limitations. Methods Syntax score II was developed by applying a Cox proportional hazards model to results of the randomised all comers Syntax trial (n=1800). Baseline features with strong associations to 4-year mortality in either the CABG or the PCI settings (interactions), or in both (predictive accuracy), were added to the anatomical Syntax score. Comparisons of 4-year mortality predictions between CABG and PCI were made for each patient. Discriminatory performance was quantified by concordance statistics and internally validated with bootstrap resampling. External validation was done in the multinational all comers DELTA registry (n=2891), a heterogeneous population that included patients with three-vessel disease (26%) or complex coronary artery disease (anatomical Syntax score ≥33, 30%) who underwent CABG or PCI. The Syntax trial is registered with ClinicalTrials.gov, number NCT00114972. Findings Syntax score II contained eight predictors: anatomical Syntax score, age, creatinine clearance, left ventricular ejection fraction (LVEF), presence of unprotected left main coronary artery (ULMCA) disease, peripheral vascular disease, female sex, and chronic obstructive pulmonary disease (COPD). Syntax score II significantly predicted a difference in 4-year mortality between patients undergoing CABG and those undergoing PCI (p interaction 0·0037). To achieve similar 4-year mortality after CABG or PCI, younger patients, women, and patients with reduced LVEF required lower anatomical Syntax scores, whereas older patients, patients with ULMCA disease, and those with COPD, required higher anatomical Syntax scores. Presence of diabetes was not important for decision making between CABG and PCI (p interaction 0·67). Syntax score II discriminated well in all patients who underwent CABG or PCI, with concordance indices for internal (Syntax trial) validation of 0·725 and for external (DELTA registry) validation of 0·716, which were substantially higher than for the anatomical Syntax score alone (concordance indices of 0·567 and 0·612, respectively). A nomogram was constructed that allowed for an accurate individualised prediction of 4-year mortality in patients proposing to undergo CABG or PCI. Interpretation Long-term (4-year) mortality in patients with complex coronary artery disease can be well predicted by a combination of anatomical and clinical factors in Syntax score II. Syntax score II can better guide decision making between CABG and PCI than the original anatomical Syntax score. Funding Boston Scientific Corporation.
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the Syntax score and Syntax based clinical risk scores
Seminars in Thoracic and Cardiovascular Surgery, 2011Co-Authors: Vasim Farooq, Salvatore Brugaletta, Patrick W SerruysAbstract:Risk stratification is an important and essential component in appropriately informing patients electing to undergo coronary artery bypass graft or percutaneous coronary intervention. This process is an integral part of the Syntax pioneered Heart Team approach in selecting the most appropriate revascularization modality in patients with complex coronary artery disease. The Syntax score was pioneered as an anatomical-based risk score that aided in this decision-making process. The purpose of this review is to examine the Syntax score and subsequent risk models that have been developed on the basis of this landmark anatomical-based risk score.
David R Holmes - One of the best experts on this subject based on the ideXlab platform.
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response to letter regarding article quantification of incomplete revascularization and its association with five year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery Syntax trial validation of the r
Circulation, 2014Co-Authors: Vasim Farooq, Yaojun Zhang, Patrick W Serruys, Christos V Bourantas, David R Holmes, Michael J Mack, Takashi Muramatsu, Ted Feldman, Marie Claude Morice, Elisabeth StahleAbstract:We thank Carnero-Alcazar and colleagues for their comments concerning our article.1 First, the readership should be reminded that the anatomic Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (Syntax) score was designed before the Syntax trial as a tool to force the interventional cardiologist and cardiac surgeon to systematically analyze the coronary angiogram and agree that “equivalent anatomic revascularization” could be achieved on the basis of a vessel size of 1.5 mm. A vessel size of 1.5 mm was selected as this was the size of the vessel the cardiac surgeon stated they could revascularize. Before the Syntax trial, the Syntax score was tested in the Arterial Revascularization Therapies Study (ARTS) II Study.2 In the Syntax trial protocol, outcomes related to the Syntax score were prespecified. Since the Syntax trial, numerous studies have validated the Syntax score.3 Second, criticisms related to the reproducibility of the Syntax score appear excessive. The simple interpretation of a coronary angiogram, on which most contemporary …
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quantification of incomplete revascularization and its association with five year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery Syntax trial validation of the residual Syntax score
Circulation, 2013Co-Authors: Vasim Farooq, Yaojun Zhang, Patrick W Serruys, Christos V Bourantas, David R Holmes, Michael J Mack, Takashi Muramatsu, Ted Feldman, Marie Claude Morice, Elisabeth StahleAbstract:Background—The residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (Syntax) Score is an objective measure of the degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). Methods and Results—In the randomized PCI cohort of the Syntax Trial (n=903), the baseline and residual Syntax Scores were calculated. Subjects with a residual Syntax Score of 0 were defined as having undergone complete revascularization (CR), and a residual Syntax Score >0 as incomplete revascularization (ICR). Five-year clinical outcomes were stratified by CR and ICR (tertiles of the residual Syntax Score: >0–4, >4–8, and >8). In the PCI cohort, the mean baseline and residual Syntax Scores were 28.4±11.5 and 4.5±6.9, respectively. The mean Δ Syntax Score (representative of the burden of disease removed by PCI) was 23.8±10.9. The residual Syntax Score was distributed as follows: CR, 0 (n=386, 42.7%); ICR, >0 to 4 (n=184, 20.4%), >4 to 8 (n=167, 18.5%), >8 (n=153, 16...
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anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients development and validation of Syntax score ii
The Lancet, 2013Co-Authors: Vasim Farooq, Arie Pieter Kappetein, Ewout W Steyerberg, David Van Klaveren, Yvonne Vergouwe, Emanuele Meliga, Alaide Chieffo, Antonio Colombo, David R Holmes, Michael J MackAbstract:Summary Background The anatomical Syntax score is advocated in European and US guidelines as an instrument to help clinicians decide the optimum revascularisation method in patients with complex coronary artery disease. The absence of an individualised approach and of clinical variables to guide decision making between coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) are limitations of the Syntax score. Syntax score II aimed to overcome these limitations. Methods Syntax score II was developed by applying a Cox proportional hazards model to results of the randomised all comers Syntax trial (n=1800). Baseline features with strong associations to 4-year mortality in either the CABG or the PCI settings (interactions), or in both (predictive accuracy), were added to the anatomical Syntax score. Comparisons of 4-year mortality predictions between CABG and PCI were made for each patient. Discriminatory performance was quantified by concordance statistics and internally validated with bootstrap resampling. External validation was done in the multinational all comers DELTA registry (n=2891), a heterogeneous population that included patients with three-vessel disease (26%) or complex coronary artery disease (anatomical Syntax score ≥33, 30%) who underwent CABG or PCI. The Syntax trial is registered with ClinicalTrials.gov, number NCT00114972. Findings Syntax score II contained eight predictors: anatomical Syntax score, age, creatinine clearance, left ventricular ejection fraction (LVEF), presence of unprotected left main coronary artery (ULMCA) disease, peripheral vascular disease, female sex, and chronic obstructive pulmonary disease (COPD). Syntax score II significantly predicted a difference in 4-year mortality between patients undergoing CABG and those undergoing PCI (p interaction 0·0037). To achieve similar 4-year mortality after CABG or PCI, younger patients, women, and patients with reduced LVEF required lower anatomical Syntax scores, whereas older patients, patients with ULMCA disease, and those with COPD, required higher anatomical Syntax scores. Presence of diabetes was not important for decision making between CABG and PCI (p interaction 0·67). Syntax score II discriminated well in all patients who underwent CABG or PCI, with concordance indices for internal (Syntax trial) validation of 0·725 and for external (DELTA registry) validation of 0·716, which were substantially higher than for the anatomical Syntax score alone (concordance indices of 0·567 and 0·612, respectively). A nomogram was constructed that allowed for an accurate individualised prediction of 4-year mortality in patients proposing to undergo CABG or PCI. Interpretation Long-term (4-year) mortality in patients with complex coronary artery disease can be well predicted by a combination of anatomical and clinical factors in Syntax score II. Syntax score II can better guide decision making between CABG and PCI than the original anatomical Syntax score. Funding Boston Scientific Corporation.
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complex coronary anatomy in coronary artery bypass graft surgery impact of complex coronary anatomy in modern bypass surgery lessons learned from the Syntax trial after two years
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Friedrich W Mohr, Patrick W Serruys, David R Holmes, A Rastan, Pieter A Kappetein, Jose L Pomar, Stephen Westaby, Katrin Leadley, Keith D Dawkins, Michael J MackAbstract:Objective Syntax study compares outcomes of coronary artery bypass grafting with percutaneous coronary intervention in patients with 3-vessel and/or left main disease. Complexity of coronary artery disease was quantified by the Syntax score, which combines anatomic characteristics of each significant lesion. This study aims to clarify whether Syntax score affects the outcome of bypass grafting as defined by major adverse cerebrovascular and cardiac events (MACCE) and its components over a 2-year follow-up period. Methods Of the 3075 patients enrolled in Syntax, 1541 underwent coronary artery bypass grafting (897 randomized controlled trial patients, and 644 registry patients). All patients undergoing bypass grafting were stratified according to their Syntax score into 3 tertiles: low (0–22), intermediate (22–32), and high (≥33) complexity. Clinical outcomes up to 2 years after allocation were determined for each group and further risk factor analysis was performed. Results Registry patients had more complex disease than those in the randomized controlled trial (Syntax score: registry 37.8 ± 13.3 vs randomized 29.1 ± 11.4; P Syntax score did not significantly affect overall 2-year MACCE rate of 15.6% for low, 14.3% for medium, and 15.4% for high Syntax scores. Compared with randomized patients, registry patients had a lower rate of overall MACCE rate (registry 13.0% vs randomized 16.7%; P = .046) and repeat revascularization (4.7% vs 8.6%; P = .003), whereas other event rates were comparable. Risk factor analysis revealed left main disease ( P = .049) and incomplete revascularization ( P = .005) as predictive for adverse 2-year outcomes. Conclusions The outcome of coronary artery bypass grafting was excellent and independent from the Syntax score. Incomplete revascularization rather than degree of coronary complexity adversely affects late outcomes of coronary bypass.
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assessment of the Syntax score in the Syntax study
Eurointervention, 2009Co-Authors: Patrick W Serruys, Arie Pieter Kappetein, David R Holmes, Michael J Mack, Yoshinobu Onuma, Scot Garg, Giovanna Sarno, Marcel Van Den Brand, Nic Van Dyck, Ted FeldmanAbstract:Aims: The Syntax™ score has been designed to better anticipate the risks of percutaneous or surgical revascularisation, taking into account the functional impact of the coronary circulation with all its anatomic components including the presence of bifurcations, total occlusions, thrombus, calcification, and small vessels. The purpose of this paper is to describe the baseline assessment of the Syntax™ score in the Syntax randomised trial, the corelab reproducibility, the potential difference in score assessment between the investigator and the corelab, and to ascertain the impact on one-year outcome after either percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) in patients with complex coronary artery disease. Methods and results: To assess the reliability of Syntax™ scoring, 100 diagnostic angiograms from the Syntax trial were randomly selected and assessed independently by two observers. Intra-observer variability was assessed by analysing 91 sets of angiograms after an interval of at least eight weeks by one of the observers. Clinical outcomes in the randomised cohort of the Syntax trial up to one year are presented with stratification by tertile group of the Syntax™ score. The weighted kappa value for the inter-observer reproducibility on the global score was 0.45, while the intra-observer weighted kappa value was 0.59. The Syntax™ score as calculated by investigators consistently underscored the corelab score by 3.4 points. When the Syntax randomised cohort was stratified by tertiles of the Syntax™ score, there were similar or nonsignificantly different MACCE rates in those with low or intermediate scores; however in the top tertile the MACCE rate was greater in those receiving PCI compared to CABG. Conclusions: The Syntax™ score is a visual coronary score with an acceptable corelab reproducibility that has an impact on the one-year outcome of those having PCI, whereas it has no effect on the one-year outcome following surgical revascularisation. The Syntax™ score tool is likely to be useful in a wide range of patients with complex coronary disease.
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response to letter regarding article quantification of incomplete revascularization and its association with five year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery Syntax trial validation of the r
Circulation, 2014Co-Authors: Vasim Farooq, Yaojun Zhang, Patrick W Serruys, Christos V Bourantas, David R Holmes, Michael J Mack, Takashi Muramatsu, Ted Feldman, Marie Claude Morice, Elisabeth StahleAbstract:We thank Carnero-Alcazar and colleagues for their comments concerning our article.1 First, the readership should be reminded that the anatomic Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (Syntax) score was designed before the Syntax trial as a tool to force the interventional cardiologist and cardiac surgeon to systematically analyze the coronary angiogram and agree that “equivalent anatomic revascularization” could be achieved on the basis of a vessel size of 1.5 mm. A vessel size of 1.5 mm was selected as this was the size of the vessel the cardiac surgeon stated they could revascularize. Before the Syntax trial, the Syntax score was tested in the Arterial Revascularization Therapies Study (ARTS) II Study.2 In the Syntax trial protocol, outcomes related to the Syntax score were prespecified. Since the Syntax trial, numerous studies have validated the Syntax score.3 Second, criticisms related to the reproducibility of the Syntax score appear excessive. The simple interpretation of a coronary angiogram, on which most contemporary …
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quantification of incomplete revascularization and its association with five year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery Syntax trial validation of the residual Syntax score
Circulation, 2013Co-Authors: Vasim Farooq, Yaojun Zhang, Patrick W Serruys, Christos V Bourantas, David R Holmes, Michael J Mack, Takashi Muramatsu, Ted Feldman, Marie Claude Morice, Elisabeth StahleAbstract:Background—The residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (Syntax) Score is an objective measure of the degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). Methods and Results—In the randomized PCI cohort of the Syntax Trial (n=903), the baseline and residual Syntax Scores were calculated. Subjects with a residual Syntax Score of 0 were defined as having undergone complete revascularization (CR), and a residual Syntax Score >0 as incomplete revascularization (ICR). Five-year clinical outcomes were stratified by CR and ICR (tertiles of the residual Syntax Score: >0–4, >4–8, and >8). In the PCI cohort, the mean baseline and residual Syntax Scores were 28.4±11.5 and 4.5±6.9, respectively. The mean Δ Syntax Score (representative of the burden of disease removed by PCI) was 23.8±10.9. The residual Syntax Score was distributed as follows: CR, 0 (n=386, 42.7%); ICR, >0 to 4 (n=184, 20.4%), >4 to 8 (n=167, 18.5%), >8 (n=153, 16...
