title: Short-term and long-term clinical impact of stent thrombosis and graft occlusion in the SYNTAX trial at 5 years: Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery trial.
abstract: OBJECTIVE
  The aim of this study was to report the short-term and long-term clinical impact of stent thrombosis (ST) and graft occlusion (GO) in the final 5-year outcomes of the SYNTAX (SYNergy Between PCI With TAXUS and Cardiac Surgery) trial.
  
  
  BACKGROUND
  The clinical effect of newer-generation drug-eluting stents and operative factors in complex coronary artery disease is uncertain.
  
  
  METHODS
  The incidence of 5-year ST and GO, and their association with clinical outcomes, were analyzed in the randomized percutaneous coronary intervention and coronary artery bypass graft cohorts. ST and GO were defined by the SYNTAX protocol definitions (clinical presentation with acute coronary syndrome and angiographic/pathological evidence), the Academic Research Consortium (ARC) definition for ST, and the newly devised "ARC-like" definition of GO (i.e., definite, probable, or possible GO).
  
  
  RESULTS
  At 5 years, 871 of 903 patients (96.5%) in the percutaneous coronary intervention cohort and 805 of 897 patients (89.7%) in the coronary artery bypass graft cohort completed follow-up. As compared with other vessel locations, protocol ST (72 lesions) occurred more frequently in the left main (14 of 72; 19%) and proximal coronary vasculature (37 of 72; 51%) and protocol GO (41 lesions) with grafts anastomosed to the distal right coronary artery (17 of 41; 42%). The incidence of 5-year ARC definite ST and ARC-like definite GO did not significantly differ (7% [n = 48] vs. 6% [n = 32], log rank p = 0.34); landmark analyses indicated significantly increased ARC definite ST within 30 days (3% [n = 19] vs. 1% [n = 6], log rank p = 0.033) but not >30 days to 5 years (4.2% [n = 29] vs. 4.5% [n = 26], log rank p = 0.78). At presentation, ARC definite ST (n = 48) and ARC-like definite GO (n = 32) were adjudicated to be linked to 4 (8%) and 0 deaths, respectively. At 5 years, ARC definite ST (n = 48) and ARC definite/probable ST (n = 75) were associated with 17 (17 of 48, 35.4%; median days to death: 0 days; interquartile range: 0 to 16 days; maximum: 321 days) and 31 (31 of 75, 41.3%; median: 0 days; interquartile range: 0 to 9 days; maximum: 721 days) cardiac deaths, respectively. At 5 years, ARC-like definite GO (n = 32) and ARC-like definite/probable GO (n = 53) were associated with 0 and 12 (12 of 52, 23.1%; median: 0 days; interquartile range: 0 to 14 days; maximum: 257 days) cardiac deaths, respectively.
  
  
  CONCLUSIONS
  Although the incidence of ST and GO was similar at 5 years, the clinical impact of ST appeared greater, with a negative impact on short-term to long-term mortality.
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
authors.forename: Vasim
authors.initials: V
authors.lastname: Farooq
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands. Electronic address: p.w.j.c.serruys@erasmusmc.nl.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
authors.forename: Yaojun
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Medical City Dallas Hospital, Dallas, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
authors.affiliation: University Hospital Uppsala, Uppsala, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ståhle
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.affiliation: Evanston Hospital, Evanston, Illinois.
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
authors.affiliation: Institut Jacques Cartier, Massy, France.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
authors.forename: Christos V
authors.initials: CV
authors.lastname: Bourantas
authors.affiliation: Cardialysis BV, Rotterdam, the Netherlands.
authors.forename: Ton
authors.initials: T
authors.lastname: de Vries
authors.affiliation: Cardialysis BV, Rotterdam, the Netherlands.
authors.forename: Marie-Angèle
authors.initials: MA
authors.lastname: Morel
authors.affiliation: Boston Scientific Corporation, Natick, Massachusetts.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
authors.forename: Arie Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.affiliation: Herzzentrum, Leipzig, Germany.
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000639:trends*; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000639:trends*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000639:trends*; D011446:Prospective Studies; D020946:Taxus; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome
keywords: ARC; Academic Research Consortium; CABG; CEC; GO; KM; Kaplan-Meier; LAD; LIMA; MI; PCI; RIMA; ST; SYNTAX; ULMCA; clinical events committee; coronary artery bypass graft; graft occlusion; left anterior descending artery; left internal mammary artery; mortality; myocardial infarction; percutaneous coronary intervention; right internal mammary artery; stent thrombosis; unprotected left main coronary artery