title: Impact of Baseline Angiographic Complexities Determined by Coronary Artery Bypass Grafting SYNTAX Score on the Prediction of Outcome After Percutaneous Coronary Intervention.
abstract: Although Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score based on angiographic scoring system was developed in patients with previous coronary artery bypass grafting (CABG), few data exist regarding its prognostic utility in patients undergoing percutaneous coronary intervention (PCI). We examined 272 patients with previous CABG (217 men; mean age, 70.4 ± 9.7 years) undergoing PCI. Severity of the coronary anatomy was evaluated using CABG-SYNTAX score. The primary end point of this study was cardiovascular death. The baseline CABG-SYNTAX score ranged from 2 to 53.5, with an average of 26.0 ± 10.2. In the index procedures, PCI for the native coronary accounted for nearly all patients (88%). During follow-up (median 4.1 years), 40 cardiovascular deaths had occurred. In multivariate analysis, age >75 years (hazard ratio [HR] 2.82, 95% CI 1.45 to 5.52), left ventricular ejection fraction <40% (HR 2.99, 95% CI 1.39 to 6.07), end-stage renal disease (HR 2.90, 95% CI 1.15 to 6.75), peripheral artery disease (HR 2.20, 95% CI 1.10 to 4.64), and CABG-SYNTAX score >25 (HR 2.37, 95% CI 1.19 to 5.05) were independent predictors of cardiovascular death. After creating a composite risk score in consideration of identified predictors, the freedom from cardiovascular death at 5 years was 98%, 86%, and 58% in the low (0 to 1), medium (2), and high (3 to 5) scores, respectively (p <0.001). The area under the receiver-operating characteristic curve for cardiovascular death for the CABG-SYNTAX and composite risk scores were 0.66 and 0.77, respectively (p <0.05). In conclusion, the combination of angiographic and clinical characteristics is useful for risk stratification in patients with previous CABG undergoing PCI.
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors: Takuya
authors: T
authors: Nakahashi
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors: Kenji
authors: K
authors: Sakata
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors: Akihiro
authors: A
authors: Nomura
authors: Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan.
authors: Yohei
authors: Y
authors: Yakuta
authors: Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan.
authors: Tadatsugu
authors: T
authors: Gamou
authors: Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan.
authors: Hidenobu
authors: H
authors: Terai
authors: Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan.
authors: Yuki
authors: Y
authors: Horita
authors: Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan.
authors: Masatoshi
authors: M
authors: Ikeda
authors: Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan.
authors: Masanobu
authors: M
authors: Namura
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
authors: Masayuki
authors: M
authors: Takamura
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors: Masa-Aki
authors: MA
authors: Kawashiri
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan. Electronic address: myamagi@med.kanazawa-u.ac.jp.
authors: Masakazu
authors: M
authors: Yamagishi
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors: Kenshi
authors: K
authors: Hayashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015897:Comorbidity; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left