Complete Versus Incomplete Revascularization With Coronary Artery Bypass Graft or Percutaneous Intervention in Stable Coronary Artery Disease

Gössl, Mario; Faxon, David P.; Bell, Malcolm R.; Holmes, David R.; Gersh, Bernard J.

doi:10.1161/circinterventions.111.965509

Cited by 103 publications

(79 citation statements)

References 51 publications

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“…These studies have for example used the number of treated vessels/treated important vessels based on varying degrees of stenosis, and have analyzed IR with or without the presence of TOs, or on revascularization of all vessels with a size ≥1.5 mm. 1,[6][7][8][9][10][11][12][13][14]29 Such varying definitions of ICR have made comparisons between studies problematic. In addition, the unavoidable selection bias inherent to all registries has added to the difficulties in interpreting these studies.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] In addition, ICR has been linked to adverse short-and longer term morbidity and mortality. [6][7][8][9][10][11][12][13][14] Recently, the concept of reasonable incomplete revascularization has been proposed, 7,8,11,13,15 the underlying principle being that an acceptable burden of obstructive coronary artery disease post revascularization to be associated with similar outcomes to subjects in whom complete revascularization (CR) was achieved.…”

mentioning

confidence: 99%

“…Furthermore, the residual SYNTAX Score allowed for a threshold value of ICR to be determined that would not have a negative impact on long-term mortality (ie, the concept of reasonable incomplete revascularization). 7,8,11,13,15 This concept, using the residual SYNTAX Score, has recently been described in the ACUITY Trial, 16 the main differences being that the ACUITY Trial recruited subjects solely presenting with non-ST elevation acute coronary syndrome, followed up for 1-year, and importantly, with substantially lesser complex coronary artery disease (primarily single or double vessel disease, median SYNTAX Score 9.0, interquartile range 5.0-16.0). Comparatively, the SYNTAX Trial recruited subjects with substantially more complex coronary artery disease (left main or de novo 3VD, median SYNTAX Score 28, interquartile range 20.0-36.0), and validated the findings of a residual SYNTAX Score >8 to be associated with adverse outcomes at up to 5 years, in an all-comers randomized population, and in several clinical and anatomic subgroups.…”

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confidence: 99%

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Quantification of Incomplete Revascularization and its Association With Five-Year Mortality in the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) Trial Validation of the Residual SYNTAX Score

et al. 2013

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Background-The residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery(SYNTAX) Score is an objective measure of the degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). Methods and Results-In the randomized PCI cohort of the SYNTAX Trial (n=903), the baseline and residual SYNTAX Scores were calculated. Subjects with a residual SYNTAX Score of 0 were defined as having undergone complete revascularization (CR), and a residual SYNTAX Score >0 as incomplete revascularization (ICR). Five-year clinical outcomes were stratified by CR and ICR (tertiles of the residual SYNTAX Score: >0-4, >4-8, and >8). In the PCI cohort, the mean baseline and residual SYNTAX Scores were 28.4±11.5 and 4.5±6.9, respectively. The mean Δ SYNTAX Score (representative of the burden of disease removed by PCI) was 23.8±10.9. The residual SYNTAX Score was distributed as follows: CR, 0 (n=386, 42.7%); ICR, >0 to 4 (n=184, 20.4%), >4 to 8 (n=167, 18.5%), >8 (n=153, 16.9%). A progressively higher residual SYNTAX Score was shown to be a surrogate marker of increasing clinical comorbidity and anatomic complexity. Subjects with CR or residual SYNTAX Scores ≤8 had comparable 5-year mortality (CR, 8.5%; residual SYNTAX Score >0-4, 8.7%; >4-8, 11.4%; P=0.60). A residual SYNTAX Score >8 was associated with 35.3% all-cause mortality at 5-years (P<0.001). Stratified analyses in the predefined medical treated diabetic and left main subgroups yielded similar results. Conclusions-The

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Section: Discussionmentioning

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confidence: 99%

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confidence: 99%

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Quantification of Incomplete Revascularization and its Association With Five-Year Mortality in the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) Trial Validation of the Residual SYNTAX Score

et al. 2013

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“…9,10 These events are known to affect QOL and increase healthcare resource consumption, thereby demonstrating the need for additional approaches to improve outcomes in this population. 38,39 Our study included patients with ACS, so in some cases, baseline angina frequency may have been due to a thrombotic process (although we did require chronic angina >30 days prior to admission). Furthermore, there were no differences across arms in SAQ angina frequency over time in patients with or without an initial ACS.…”

Section: Discussionmentioning

confidence: 99%

Effects of Ranolazine on Angina and Quality of Life After Percutaneous Coronary Intervention With Incomplete Revascularization

et al. 2016

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Background-Angina often persists or returns in populations following percutaneous coronary intervention (PCI). We hypothesized that ranolazine would be effective in reducing angina and improving quality of life (QOL) in incomplete revascularization (ICR) post-PCI patients. Methods and Results-In RIVER-PCI, 2604 patients with a history of chronic angina who had ICR post-PCI were randomized 1:1 to oral ranolazine versus placebo; QOL analyses included 2389 randomized subjects. Angina and QOL questionnaires were collected at baseline and months 1, 6, and 12. Ranolazine patients were more likely than placebo to discontinue study drug by month 6 (20. P=0.11). Improvement in SAQ angina frequency was observed with ranolazine at month 6 among diabetics (mean difference 3.3; 95% CI 0.6, 6.1; P=0.02) and those with more angina (baseline SAQ angina frequency ≤60; mean difference 3.4; 95% CI 0.6, 6.2; P=0.02), but was not maintained at month 12. Conclusions-Despite ICR following PCI, there was no incremental benefit in angina or QOL measures by adding ranolazine in this angiographically-identified population. These measures markedly improved within 1 month of PCI and persisted up to 1 year in both treatment arms. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01442038.

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“…Adanya faktor-faktor risiko yang lain memperberat terjadinya proses atherosklerosis. 3,11,[12][13][14] Proporsi pasien yang mengalami stroke, penyakit ginjal kronik dan infeksi dijumpai dalam jumlah kecil, baik pada kelompok BPK, IKP maupun medikamentosa. Dibandingkan kelompok IKP dan medikamentosa, proporsi stroke pada kelompok BPK paling besar (16.1%).…”

Section: Karakteristikunclassified

Kesintasan Lima Tahun Pasien Penyakit Jantung Koroner Tiga Pembuluh Darah dengan Diabetes Melitus yang Menjalani Bedah Pintas Koroner, Intervensi Koroner Perkutan atau Medikamentosa di Rumah Sakit dr. Cipto Mangunkusumo

Setiawan¹,

Panggabean²,

Yamin³

et al. 2017

JPDI

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ABSTRAKPendahuluan. Hasil revaskularisasi pada pasien diabetes melitus (DM) dengan penyakit jantung koroner 3 pembuluh darah (PJK 3PD) dengan bedah pintas koroner (BPK) lebih baik dibandingkan intervensi koroner perkutan (IKP) atau medikamentosa. BPK tidak selalu menjadi prosedur yang dikerjakan meskipun sudah direkomendasikan sesuai Skor Syntax. Selain itu, tidak semua pasien bersedia menjalani BPK atau IKP. Perlu diketahui apakah pilihan revaskularisasi tersebut mempengaruhi kesintasan 5 tahun.Metode. Penelitian ini merupakan studi kohort retrospektif dengan pendekatan analisis kesintasan untuk meneliti kesintasan 5 tahun pasien PJK 3PD DM yang menjalani tindakan BPK, IKP atau medikamentosa. Penelitian dilakukan dengan menggunakan data sekunder 126 pasien PJK 3PD DM yang menjalani BPK, IKP, maupun medikamentosa di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta pada tahun 2006-2007 dan diikuti sampai dengan tahun 2011-2012 dengan dilihat adakah kejadian meninggal.Hasil. Kesintasan terbaik diketahui yaitu pada kelompok BPK (93,5%). Proporsi kematian terbesar terdapat pada kelompok medikamentosa (36,1%). Selain itu, hasil analisis menunjukkan bahwa kelompok IKP memiliki kesintasan yang lebih baik dibanding medikamentosa (69,5% vs 63,9%). Meskipun tidak bermakna secara statistik, namun pada kelompok IKP proporsi keluhan yang ditemukan setelah tindakan lebih sedikit dibanding kelompok medikamentosa (52% vs 38%). Skor Syntax yang berperan menilai kompleksitas stenosis diketahui turut menentukan kesintasan (p= 0,039).Simpulan. Kesintasan 5 tahun pasien PJK 3PD dengan DM yang paling baik didapatkan pada kelompok yang menjalani BPK. Kesintasan 5 tahun pasien PJK 3PD dengan DM yang menjalani IKP lebih baik dibandingkan medikamentosa, namun secara statistik tidak bermakna. Faktor yang berpengaruh pada kesintasan 5 tahun pasien PJK 3PD adalah kompleksitas stenosis yang dilihat dengan menggunakan skor Syntax. Kata kunci: DM, kesintasan 5 tahun, PJK 3PD

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Complete Versus Incomplete Revascularization With Coronary Artery Bypass Graft or Percutaneous Intervention in Stable Coronary Artery Disease

Cited by 103 publications

References 51 publications

Quantification of Incomplete Revascularization and its Association With Five-Year Mortality in the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) Trial Validation of the Residual SYNTAX Score

Quantification of Incomplete Revascularization and its Association With Five-Year Mortality in the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) Trial Validation of the Residual SYNTAX Score

Effects of Ranolazine on Angina and Quality of Life After Percutaneous Coronary Intervention With Incomplete Revascularization

Kesintasan Lima Tahun Pasien Penyakit Jantung Koroner Tiga Pembuluh Darah dengan Diabetes Melitus yang Menjalani Bedah Pintas Koroner, Intervensi Koroner Perkutan atau Medikamentosa di Rumah Sakit dr. Cipto Mangunkusumo

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