10 Years of SYNTAX

Serruys, Patrick W.; Revaiah, Pruthvi C; Ninomiya, Kai; Masuda, Shinichiro; Kotoku, Nozomi; Kageyama, Shigetaka; Onuma, Yoshinobu; Morel, Marie Angèle; Garg, Scot; Feldman, Ted; Kappetein, Arie Pieter; Holmes, David R.; Mohr, Friedrich–Wilhelm

doi:10.1016/j.jacasi.2023.03.014

Cited by 8 publications

(5 citation statements)

References 47 publications

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“…However, for advanced atherosclerotic cardiovascular disease patients, increased risks for recurrent events can still be foreseen during long-term follow-up despite an early coronary revascularization strategy and guideline-recommended medical therapy, an issue commonly described in clinical practice as the problem of 'residual risk' [3,22,23]. Cholesterol undoubtedly represented a major residual risk factor and was de ned as an unachieved LDL-C level goal despite current lipid-lowering therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Statins has been recognized as the cornerstone of cardiovascular secondary prevention due to their effectiveness in lowering the rates of recurrent myocardial infarction, stroke and cardiovascular deaths, which has been substantiated in previous randomized controlled trials [2]. However, statin-treated patients, especially those with advanced atherosclerotic cardiovascular disease (ASCVD), still suffer from a relatively high incidence of MACCEs even after an early revascularization strategy, an issue commonly ascribed to the problem of 'residual risk' [3]. RCR, de ned as an unachieved LDL-C goal in clinical practice despite contemporary statin treatment, undoubtedly represents a residual risk factor and provides evidence for large-scale clinical trials targeting more aggressive lipid-lowering therapies.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Temporal Trend in Inflammatory and Cholesterol Risk on the Prognosis of Percutaneous Coronary Intervention-Treated Patients with Contemporary Statin Therapy

Gao,

Qiu,

Wang

et al. 2023

Preprint

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Background Atherosclerotic cardiovascular disease patients still suffer from recurrent vascular events due to residual cholesterol and inflammatory risk. However, the relative importance of inflammation and cholesterol risk might have changed in percutaneous coronary intervention (PCI)-treated patients after accepting contemporary statin therapy. Hence, this study aims to evaluate the effect of temporal trend in inflammatory and cholesterol risk on the prognosis of that population. Methods PCI-treated patients at Fuwai Hospital between 1st January 2016 and 31st December 2017 with on-admission and follow-up high-sensitive C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C) within 1 to 3 months were retrospectively enrolled. Participants were all taking contemporary statin treatment at discharge. Tertiles of on-admission and follow-up hs-CRP (a biomarker for inflammatory risk) and LDL-C (a biomarker for cholesterol risk) were assessed as determinants of one-year major adverse cardiovascular and cerebrovascular events (MACCEs). Multivariable Cox proportional hazard model was used to evaluate the prognostic value of on-admission, follow-up cholesterol and inflammatory risk. High inflammatory or cholesterol risk after accepting contemporary statins were expressed as residual cholesterol risk (RCR), residual inflammatory risk (RIR) and residual cholesterol and inflammatory risk (RCIR). Subgroup analysis of inflammatory and cholesterol risk on admission was conducted based on the glycometabolic status, index presentation and guideline-recommended statin therapy (GRST) at discharge. Results After one-year of follow-up, 187 MACCEs occurred in 2373 participants. Among the on-admission and follow-up hsCRP and LDL-C tetiles, only the follow-up LDL-C tertile failed to predict the occurrence of MACCEs [T3 versus T1, adjusted hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.61–1.29, P = 0.544]. After adjusting for various confounding factors, on-admission high cholesterol and inflammatory risk was significantly associated with the incidence of MACCEs (HR 2.45 95%CI 2.45 1.42–4.21, P < 0.001). RIR can be a major determinant of MACCEs (adjusted HR 4.43, 95% CI 2.82–6.98, P < 0.001). Subgroup analysis showed the potential predictive role of on-admission high inflammatory risk only for MACCEs in those with diabetes mellitus (HR 2.35, 95% CI 1.01–5.43) and accepting underpowered statins at discharge (HR 2.16, 95% CI 1.05–4.41). Conclusion We observed a combined effect of on-admission high cholesterol and inflammatory risk that could predict the risk of MACCEs. Inflammatory risk assessed by hs-CRP was a stronger predictor for MACCEs than cholesterol risk assessed by LDL-C in PCI-treated patients after taking contemporary statin therapy. Additionally, on-admission high inflammatory risk only could independently predict cardiovascular outcomes in PCI-treated patients with diabetes mellitus and accepting underpowered statin therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Temporal Trend in Inflammatory and Cholesterol Risk on the Prognosis of Percutaneous Coronary Intervention-Treated Patients with Contemporary Statin Therapy

Gao,

Qiu,

Wang

et al. 2023

Preprint

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“…[1] The baseline characteristics of patients enrolled in randomized control trials (RCTs) of complex CAD are inherently related to the study's inclusion and exclusion criteria. [2] The anatomical SYNTAX score (aSS), which is recommended by the European Society of Cardiology (ESC) and American College of Cardiology (ACC) guidelines for revascularization, semi-quantifies the extent and the complexity of CAD and helps stratify the risk of revascularization following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). [3,4] In 2020, the SYNTAX score II 2020 (SS2020) was redeveloped to predict 5-year mortality in patients with three-vessel disease (3VD) and/or left main (LM) CAD following PCI or CABG, combining anatomical complexity assessment and seven clinical prognostic factors identified by Cox regression: age, medically treated diabetes mellitus with or without insulin, chronic obstructive pulmonary disease (COPD), peripheral vascular disease (PVD), current smoking, creatinine clearance (CrCl), and left ventricular ejection fraction (LVEF).…”

Section: Introductionmentioning

confidence: 99%

A systematic screening and heart team approach contributes to unravel novel risk factors in revascularisation candidates of complex coronary artery disease: a machine learning approach

Kageyama,

Ninomiya,

Jonik

et al. 2024

Polish Archives of Internal Medicine

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In randomized control trials, established baseline risk factors for mortality of patients with 3VD with/without LM disease candidate for mechanical revascularization may diverge from risks encountered in daily clinical practice. By creating a specific linear model based on Cox regression after LASSO selection of new risk factors specific to the registry, we considerably improved the accuracy of the probabilistic formula in internal validation. In the present registry that included a population of all comers amenable to either surgical or percutaneous revascularization, systematic screening by Heart Team and machine learning approach enabled the detection of specific risks not necessarily collected in randomized control trials with numerous restrictive inclusion and exclusion criteria.

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“…Percutaneous coronary intervention (PCI), especially with the availability of new drug-eluting stent (DES) technologies and new devices and drugs, has revolutionized the management of coronary artery disease (CAD) by providing effective revascularization and improving clinical outcomes [1][2][3][4][5][6]. Despite these achievements, CAD still represents the leading cause of mortality in developed countries [7,8] and the outcome is still unsatisfactory in high-risk patients [9][10][11]. Therefore, great attention has been paid so far to the identification of new risk factors [12][13][14][15] and implementation of primary and secondary prevention [16][17][18][19].…”

Section: Introduction To the Rationale Of Antiplatelet Therapy After ...mentioning

confidence: 99%

Individualization of Duration of Dual Antiplatelet Therapy after Coronary Stenting: A Comprehensive, Evidence-Based Review

Carciotto,

Costa,

Garcia-Ruiz

et al. 2023

JCM

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Dual antiplatelet therapy (DAPT), comprising aspirin and a P2Y12 receptor inhibitor, is the cornerstone of post-percutaneous coronary intervention treatment to prevent stent thrombosis and reduce the risk of adverse cardiovascular events. The selection of an optimal DAPT regimen, considering the interplay of various antiplatelet agents, patient profiles, and procedural characteristics, remains an evolving challenge. Traditionally, a standard duration of 12 months has been recommended for DAPT in most patients. While contemporary guidelines provide general frameworks, DAPT modulation with longer or shorter treatment courses followed by aspirin or P2Y12 inhibitor monotherapy are evolving towards an individualized strategy to optimize the balance between efficacy and safety. This review comprehensively examines the current landscape of DAPT strategies after coronary stenting, with a focus on emerging evidence for treatment individualization.

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10 Years of SYNTAX

Cited by 8 publications

References 47 publications

Effect of Temporal Trend in Inflammatory and Cholesterol Risk on the Prognosis of Percutaneous Coronary Intervention-Treated Patients with Contemporary Statin Therapy

Effect of Temporal Trend in Inflammatory and Cholesterol Risk on the Prognosis of Percutaneous Coronary Intervention-Treated Patients with Contemporary Statin Therapy

A systematic screening and heart team approach contributes to unravel novel risk factors in revascularisation candidates of complex coronary artery disease: a machine learning approach

Individualization of Duration of Dual Antiplatelet Therapy after Coronary Stenting: A Comprehensive, Evidence-Based Review

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