A global risk approach to identify patients with left main or 3-vessel disease who could safely and efficaciously be treated with percutaneous coronary intervention: the SYNTAX Trial at 3 years.
OBJECTIVE
The aim of this study was to assess the additional value of the Global Risk--a combination of the SYNTAX Score (SXscore) and additive EuroSCORE--in the identification of a low-risk population, who could safely and efficaciously be treated with coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI).


BACKGROUND
PCI is increasingly acceptable in appropriately selected patients with left main stem or 3-vessel coronary artery disease.


METHODS
Within the SYNTAX Trial (Synergy between PCI with TAXUS and Cardiac Surgery Trial), all-cause death and major adverse cardiac and cerebrovascular events (MACCE) were analyzed at 36 months in low (GRC(LOW)) to high Global Risk groups, with Kaplan-Meier, log-rank, and Cox regression analyses.


RESULTS
Within the randomized left main stem population (n = 701), comparisons between GRC(LOW) groups demonstrated a significantly lower mortality with PCI compared with CABG (CABG: 7.5%, PCI: 1.2%, hazard ratio [HR]: 0.16, 95% confidence interval [CI]: 0.03 to 0.70, p = 0.0054) and a trend toward reduced MACCE (CABG: 23.1%, PCI: 15.8%, HR: 0.64, 95% CI: 0.39 to 1.07, p = 0.088). Similar analyses within the randomized 3-vessel disease population (n = 1,088) demonstrated no statistically significant differences in mortality (CABG: 5.2%, PCI: 5.8%, HR: 1.14, 95% CI: 0.57 to 2.30, p = 0.71) or MACCE (CABG: 19.0%, PCI: 24.7%, HR: 1.35, 95% CI: 0.95 to 1.92, p = 0.10). Risk-model performance and reclassification analyses demonstrated that the EuroSCORE-with the added incremental benefit of the SXscore to form the Global Risk-enhanced the risk stratification of all PCI patients.


CONCLUSIONS
In comparison with the SXscore, the Global Risk, with a simple treatment algorithm, substantially enhances the identification of low-risk patients who could safely and efficaciously be treated with CABG or PCI.
Department of Interventional Cardiology, Erasmus University, Medical Centre, Thoraxcenter, Rotterdam, the Netherlands. p.w.j.c.serruys@erasmusmc.nl
Patrick W
PW
Serruys
Vasim
V
Farooq
Pascal
P
Vranckx
Chrysafios
C
Girasis
Salvatore
S
Brugaletta
Hector M
HM
Garcia-Garcia
David R
DR
Holmes
Arie-Pieter
AP
Kappetein
Michael J
MJ
Mack
Ted
T
Feldman
Marie-Claude
MC
Morice
Elisabeth
E
Ståhle
Stefan
S
James
Antonio
A
Colombo
Peggy
P
Pereda
Jian
J
Huang
Marie-Angèle
MA
Morel
Gerrit-Anne
GA
Van Es
Keith D
KD
Dawkins
Friedrich W
FW
Mohr
Ewout W
EW
Steyerberg
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