Simplified Angiographic Approach Compared With SYNTAX Score for Left Main Coronary Artery Stenting
February 12, 2018—Pil Hyung Lee et al published a study online in Circulation: Cardiovascular Interventions comparing the prognostic value of Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score versus a simplified angiographic approach for patients with left main coronary artery disease (CAD) undergoing drug-eluting stent implantation.
As summarized in Circulation: Cardiovascular Interventions, the simpler angiographic approach classified left main CAD as either extensive (n = 819), defined as left main bifurcation lesions with an involvement of ostial left circumflex artery or as any left main lesion plus multivessel CAD, or limited (n = 453), defined as ostial/midshaft lesions or left main bifurcation lesions without an involvement of ostium of left circumflex artery, alone or plus one-vessel disease.
To conduct the comparison analysis, study investigators pooled data from four prospective Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease (PRECOMBAT) studies. The primary outcome evaluated was a major adverse cardiac event (MACE), defined as death, myocardial infarction, or repeat revascularization.
Investigators noted in Circulation: Cardiovascular Interventions that during follow-up (median, 38 months; interquartile range, 36–61 months), the risk for MACE was significantly higher in patients with extensive rather than with limited left main CAD (adjusted hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.54−2.94; P < .001). The risk for a composite outcome of death or myocardial infarction was also higher with extensive left main CAD (adjusted HR, 1.75; 95% CI, 1.08−2.85; P = .02). According to the investigators, the SYNTAX score data did not effectively stratify these two outcome measures.
The simple angiographic approach yielded better discernment for future cardiovascular events in patients with left main CAD undergoing drug-eluting stent implantation than SYNTAX score, concluded the investigators in Circulation: Cardiovascular Interventions.