title: Validation of the Coronary Artery Bypass Graft SYNTAX Score (Synergy Between Percutaneous Coronary Intervention With Taxus) as a Prognostic Marker for Patients With Previous Coronary Artery Bypass Graft Surgery After Percutaneous Coronary Intervention.
abstract: The efficacy and prognosis of percutaneous coronary intervention (PCI) as secondary revascularization in patients with previous coronary artery bypass graft surgery remain uncertain.
  
  
  
  We retrospectively evaluated 434 consecutive patients with previous coronary artery bypass graft surgery hospitalized for PCI between 2004 and 2011 (men 84%, age 71 (interquartile range, 66-76) years) and calculated the coronary artery bypass graft Synergy Between Percutaneous Coronary Intervention With Taxus score (CSS) before (baseline CSS) and after PCI (post-PCI CSS). Patients were divided into 2 groups based on median post-PCI CSS: low-score (≤23; n=217) and high-score groups (>23; n=217). Major adverse cardiovascular events (MACE) were defined as the composite of cardiovascular death, myocardial infarction, and unplanned repeat revascularization for myocardial ischemia. The median baseline and post-PCI CSS were 30 (interquartile range, 21-40) and 23 (interquartile range, 14.5-33.5), respectively. During a median follow-up of 69 months, the prevalence of MACE and cardiac death differed significantly between the 2 post-PCI CSS groups (MACE: low, 13.8%; high, 28.6%; P<0.001; cardiac death: low, 6.2%; high, 16.7%; P=0.002). In multivariable analysis, the high post-PCI CSS divided by the median was associated with substantially greater cumulative MACE (hazard ratio, 2.09; 95% confidence interval, 1.31-3.34; P=0.002) and cardiac death (hazard ratio, 2.02; 95% confidence interval, 1.03-3.98; P=0.042) compared with the low post-PCI CSS. Net reclassification improvement analysis revealed that post-PCI CSS resulted in significantly improved prediction of MACE and cardiac death compared with baseline CSS.
  
  
  
  In this external validation study, the CSS was a potential prognostic factor after subsequent PCI, even for previous coronary artery bypass graft surgery patients.
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Tadayoshi
authors: T
authors: Miyagi
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.). asaumi.yasuhide.hp@ncvc.go.jp.
authors: Yasuhide
authors: Y
authors: Asaumi
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Kunihiro
authors: K
authors: Nishimura
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Takahiro
authors: T
authors: Nakashima
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Hiroki
authors: H
authors: Sakamoto
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Kazuhiro
authors: K
authors: Nakao
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Tomoaki
authors: T
authors: Kanaya
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Toshiyuki
authors: T
authors: Nagai
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Yuji
authors: Y
authors: Shimabukuro
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Yoshihiro
authors: Y
authors: Miyamoto
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Tomoyuki
authors: T
authors: Fujita
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Kengo
authors: K
authors: Kusano
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Toshihisa
authors: T
authors: Anzai
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Junjirou
authors: J
authors: Kobayashi
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Teruo
authors: T
authors: Noguchi
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Hisao
authors: H
authors: Ogawa
authors: From the Department of Cardiovascular Medicine (T.M., Y.A., T. Nakashima, H.S., K.N., T.K., T. Nagai, K.K., T.A., T. Noguchi, S.Y.), Department of Preventive Medicine and Epidemiologic Informatics (K.N., Y.M.), and Department of Cardiovascular Surgery (T.F., J.K.), National Cerebral and Cardiovascular Center Hospital, Suita, Japan; Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan (T.M., Y.S.); Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.M., T.A., S.Y.); and National Cerebral and Cardiovascular Center, Suita, Japan (H.O.).
authors: Satoshi
authors: S
authors: Yasuda
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
keywords: coronary artery bypass; coronary artery disease; myocardial revascularization; percutaneous coronary intervention; standard of care