The Utility of the SYNTAX Score II and SYNTAX Score 2020 for Identifying Patients with Three-Vessel Disease Eligible for Percutaneous Coronary Intervention in the Multivessel TALENT Trial: A Prospective Pilot Experience

Ninomiya K, Serruys PW, Garg S, Hara H, Masuda S, Kageyama S, Kotoku N, Sevestre E, Kumar A, O'Kane P, Zaman A, Farah B, Magro M, Oemrawsingh RM, Mollmann H, Meneveau N, Achenbach S, Lemoine J, Allali A, Gallagher S, Wykrzykowska J, Lesiak M, Silvestri M, Wijns W, Sharif F, Onuma Y (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Book Volume: 23

Journal Issue: 4

DOI: 10.31083/j.rcm2304133

Abstract

Background: Personalized prognosis plays a vital role in deciding between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD). The aim of this study is to compare the modality of revascularization chosen by the local heart team to that recommended by using individualized predictions of medium, and long-term all-cause mortality amongst patients with 3VD screened in the Multivessel TALENT trial. Methods: The SYNTAX score II (SS-II) and SS-2020 were evaluated in 200 consecutive patients by a core laboratory and compared to the decision of the "on site" heart team. Results: According to the SS-II, CABG was the recommended treatment in 51 patients (25.5%) however 34 (66.6%) of them received PCI. According to SS-2020 the predicted absolute risk differences (ARD) between PCI and CABG were significantly higher in patients receiving CABG compared to those treated by PCI for major adverse cardiovascular and cerebrovascular events, a composite of all-cause mortality, stroke or myocardial infarction at 5-years (8.8 +/- 4.6% vs 6.0 +/- 4.0%, p < 0.001) and all-cause mortality at 5- (5.2 +/- 3.5% vs 3.7 +/- 3.0%, p = 0.008) and 10-years (9.3 +/- 4.8% vs 6.2 +/- 4.2%, p < 0.001). Based on the novel threshold of equipoise (individual absolute risk differences [ARD]<4.5%), 133 patients were eligible for PCI however 23 of them underwent CABG; conversely, amongst the 67 patients where CABG was recommendation (individual ARD>4.5%), only 19 received it. Conclusions: Despite the robustness of the risk models proposed for screening, several deviations from the recommended mode of revascularization were observed by the core laboratory among the first 200 patients with 3VD screened in the Multivessel TALENT trial. Clinical Trial Registration: ClinicalTrials.gov reference: NCT04390672.

Authors with CRIS profile

Involved external institutions

National University of Ireland (NUI), Galway Ireland (IE) Wrightington, Wigan and Leigh NHS Foundation Trust United Kingdom (GB) St.-Johannes-Hospital Germany (DE) Clinique Axium France (FR) Elisabeth-TweeSteden Ziekenhuis Netherlands (NL) Albert Schweitzer Ziekenhuis Netherlands (NL) Cardiff and Vale University Health Board United Kingdom (GB) Hôpital Jean-Minjoz France (FR) University Medical Center Groningen (UMCG) / Universitair Medisch Centrum Groningen Netherlands (NL) Poznan University of Medical Sciences / Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu Poland (PL) Newcastle upon Tyne Hospitals NHS Foundation Trust United Kingdom (GB) Segeberger Kliniken Germany (DE) Clinique Pasteur France (FR) Royal Bournemouth Hospital United Kingdom (GB) Clinique Louis Pasteur France (FR) Royal Blackburn Teaching Hospital United Kingdom (GB)

How to cite

APA:

Ninomiya, K., Serruys, P.W., Garg, S., Hara, H., Masuda, S., Kageyama, S.,... Onuma, Y. (2022). The Utility of the SYNTAX Score II and SYNTAX Score 2020 for Identifying Patients with Three-Vessel Disease Eligible for Percutaneous Coronary Intervention in the Multivessel TALENT Trial: A Prospective Pilot Experience. Reviews in Cardiovascular Medicine, 23(4). https://dx.doi.org/10.31083/j.rcm2304133

MLA:

Ninomiya, Kai, et al. "The Utility of the SYNTAX Score II and SYNTAX Score 2020 for Identifying Patients with Three-Vessel Disease Eligible for Percutaneous Coronary Intervention in the Multivessel TALENT Trial: A Prospective Pilot Experience." Reviews in Cardiovascular Medicine 23.4 (2022).

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