title: Implantation of the biodegradable polymer biolimus-eluting stent in patients with high SYNTAX score is associated with decreased cardiac mortality compared to a permanent polymer sirolimus-eluting stent: two year follow-up results from the "all-comers" LEADERS trial.
abstract: BACKGROUND
  The SYNTAX score (SXscore) has been shown to be an effective predictor of clinical outcomes in patients undergoing percutaneous coronary intervention (PCI).
  
  
  RESULTS
  The SXscore was prospectively collected in 1,397 of the 1,707 patients enrolled in the "all-comers" LEADERS trial (patients post-surgical revascularisation were excluded). Post hoc analysis was performed by stratifying clinical outcomes at two-year follow-up, according to one of three SXscore tertiles: SXlow ≤8 (n=464), 8<SXmid ≤16 (n=472) and SXhigh >16 (n=461). At two-year follow-up the rate of major adverse cardiovascular events was 18.4%, 12.0% and 9.4% in the SXhigh, SXmid, and SXlow tertile, respectively (HR 1.45; CI 1.21-1.74; p<0.01). There was a significantly higher rate of cardiac death in patients in the highest SXscore tertile (7% SXhigh versus 2.4% SXmid versus 1.8% SXlow; HR 2.22; CI 1.5-3.27; p<0.001). Within the SXhigh tertile the rate of cardiac death was significantly lower in patients treated with the biolimus-eluting stent compared with the sirolimus-eluting stent (4.7% versus 9.6%, HR 0.48; CI 0.23-0.99; p=0.046).
  
  
  CONCLUSIONS
  The SXscore when applied to an "all-comers" patient population allows for prospective risk stratification of patients undergoing PCI up to two years follow-up. In addition, the SXscore appears to separate the performance of devices in high risk patient groups.
authors.affiliation: Department of Interventional Cardiology Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Joanna J
authors.initials: JJ
authors.lastname: Wykrzykowska
authors.forename: Scot
authors.initials: S
authors.lastname: Garg
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Ton
authors.initials: T
authors.lastname: de Vries
authors.forename: Marie-Angele
authors.initials: MA
authors.lastname: Morel
authors.forename: Gerrit-Anne
authors.initials: GA
authors.lastname: van Es
authors.forename: Pawel
authors.initials: P
authors.lastname: Buszman
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.forename: Thomas
authors.initials: T
authors.lastname: Ischinger
authors.forename: Volker
authors.initials: V
authors.lastname: Klauss
authors.forename: Roberto
authors.initials: R
authors.lastname: Corti
authors.forename: Franz
authors.initials: F
authors.lastname: Eberli
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Peter
authors.initials: P
authors.lastname: Juni
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000517:prevention & control; D054855:Drug-Eluting Stents; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011108:Polymers; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D011108:Polymers; C518022:umirolimus; D020123:Sirolimus