title: Impact of completeness of revascularization in complex coronary artery disease as measured with the SYNTAX revascularization index: An SEEDS Substudy.
abstract: OBJECTIVE
  We sought to study whether the level of completeness of revascularization as measured by the SYNTAX revascularization index (SRI) independently predicts adverse ischemic events after percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES).
  
  
  BACKGROUND
  The SRI quantifies the proportion of revascularized myocardium. It has been shown to independently predict adverse ischemic events after PCI with first-generation DES.
  
  
  METHODS
  Among 1,900 patients enrolled in a registry to evaluate safety and effectiveness of everolimus drug-eluting stent (SEEDS) for coronary revascularization, the SRI was calculated and available for 1,851 patients. The patients were stratified into three groups according to the degree of revascularization (SRI = 100% [complete revascularization], SRI = 50 to <100%, and SRI <50%). Two-year mortality and major adverse cardiac events (MACE) were compared between the groups.
  
  
  RESULTS
  The SRI ranged from 4-100%, with a mean of 85.4%. Complete revascularization was achieved in 1,190 patients, while the SRI was 50% to <100% in 472 patients and <50% in 189 patients. Two-year mortality and MACE rates were higher in patients with lower SRI. ROC analysis showed an optimal SRI cutoff of 85% for predicting the 2-year mortality risk. An SRI ≥85% was associated with a similar risk of death to complete revascularization. The SRI independently predicted 2-year mortality and MACE.
  
  
  CONCLUSIONS
  The SRI predicts mortality and adverse ischemic events in patients with complex CAD who underwent contemporary PCI with second-generation DES. Revascularizing ≥85% of the CAD burden was associated with a good prognosis and should be considered as a reasonable goal. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.|NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bettinger
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Changdong
authors.initials: C
authors.lastname: Guan
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
authors.forename: Björn
authors.initials: B
authors.lastname: Redfors
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Yuejin
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Shanxi Provincial Cardiovascular Institute, Taiyuan, China.
authors.forename: Bao
authors.initials: B
authors.lastname: Li
authors.affiliation: General Hospital of Shenyang Military Region, Shenyang, China.
authors.forename: Yaling
authors.initials: Y
authors.lastname: Han
authors.affiliation: Wuhan Asia Heart Hospital, Wuhan, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Su
authors.affiliation: The 1st Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, China.
authors.forename: Zuyi
authors.initials: Z
authors.lastname: Yuan
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.|NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York.|Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada.|Morristown Medical Center, Morristown, New Jersey.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
mesh_terms: D000368:Aged; D001208:Asia; D002317:Cardiovascular Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003661:Decision Support Techniques; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus
keywords: SYNTAX revascularization index; SYNTAX score; coronary artery disease; percutaneous coronary intervention; reasonable revascularization