Long-term outcomes of patients with complex coronary artery disease according to agreement between the SYNTAX score and revascularization procedure in contemporary practice

Witberg, Guy; Lavi, Ifat; Gonen, Ophir; Assali, Abid; Vaknin‐Assa, Hana; Lev, Eli I.; Kornowski, Ran

doi:10.1097/mca.0000000000000106

Cited by 4 publications

(22 citation statements)

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“…Specifically, the studies assessed adherence to recommendations on the performance of a revascularisation in general, 23 30 a CABG, 22 24 29 a PCI/PTCA, 22 24 25 27 an ad hoc PCI, 25 26 a PCI with prior heart team discussion 26 28 and a CA. [19][20][21] Most of the studies were based on secondary data from registries, [28][29][30] patient records [21][22][23][24][25][26] or administrative data. 22 23 27 However, two studies were based on primary data obtained from prospective records of consecutive patients (eg, severity of stenosis, symptoms, procedures).…”

Section: Methods and Resultsmentioning

confidence: 99%

“…Although two of the studies prospectively collected primary data, 19 20 most used secondary data that had been collected retrospectively. [21][22][23][24][25][26][27][28][29][30] Even though secondary data often represent a more easily accessible and affordable data source, they are usually not collected for the purpose of assessing guideline adherence. As a result, the database may be non-specific (ie, information is available on a more aggregate level without providing clinical details) or incomplete (ie, required information is missing entirely).…”

Section: Data Sources and Collectionmentioning

confidence: 99%

“…19 20 24 25 29 39 Moreover, secondary data often fail to provide information on contraindications or patient preferences that could justify deviations from the guidelines. [22][23][24] The appropriateness of claims data for assessing guideline adherence might additionally be affected by factors such as the complexity of coding or economic incentives (eg, coding higher disease severity in order to generate higher payments). 40 Overall, these issues might have led to misclassification or exclusion of patients and procedures, 15 22 23 26 29 30 and, thus, contributed to a potential overestimation or underestimation of guideline adherence.…”

Section: Data Sources and Collectionmentioning

confidence: 99%

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Methods for assessing guideline adherence for invasive procedures in the care of chronic coronary artery disease: a scoping review

et al. 2023

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ObjectivesIn the care of coronary artery disease (CAD), evidence questions the adequate application of guidelines for cardiovascular procedures, particularly coronary angiographies (CA) and myocardial revascularisation. This review aims to examine how care providers’ guideline adherence for CA and myocardial revascularisation in the care of chronic CAD was assessed in the literature.DesignScoping review.Data sourcesPubMed and EMBASE were searched through in June 2021 (rerun in September 2022).Eligibility criteriaWe included studies assessing care providers’ adherence to evidence-based guidelines for CA or myocardial revascularisation in the care of chronic CAD. Studies had to list the evaluation of guideline adherence as study objective, describe the evaluation methods used and report the underlying guidelines and recommendations.Data extraction and synthesisTwo independent reviewers used standardised forms to extract study characteristics, methodological aspects such as data sources and variables, definitions of guideline adherence and quantification methods and the extent of guideline adherence. To elucidate the measurement of guideline adherence, the main steps were described.ResultsTwelve studies (311 869 participants) were included, which evaluated guideline adherence by (1) defining guideline adherence, (2) specifying the study population, (3) assigning (classes of) recommendations and (4) quantifying adherence. Thereby, primarily secondary data were used. Studies differed in their definitions of guideline adherence, where six studies each considered only recommendation class I/grade A/strong recommendations as adherent or additionally recommendation classes IIa/IIb. Furthermore, some of the studies reported a priori definitions and allocation rules for the assignment of recommendation classes. Guideline adherence results ranged from 10% for percutaneous coronary intervention with prior heart team discussion to 98% for coronary artery bypass grafting.ConclusionDue to remarkable inconsistencies in the assessment, a cautious interpretation of the guideline adherence results is required. Future efforts should endeavour to establish a consistent understanding of the concept of guideline adherence.

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Section: Methods and Resultsmentioning

confidence: 99%

Section: Data Sources and Collectionmentioning

confidence: 99%

Section: Data Sources and Collectionmentioning

confidence: 99%

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Methods for assessing guideline adherence for invasive procedures in the care of chronic coronary artery disease: a scoping review

et al. 2023

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“…[14] Even when the clinical SYNTAX score was used to predict treatment strategy, if patients with a high score disagreed to be revascularized by CABG and preferred to be treated by PCI, worse adverse outcomes were later observed.…”

Section: Discussionmentioning

confidence: 99%

Worse clinical outcomes following percutaneous coronary intervention with a high SYNTAX score

2017

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Background:The synergy between percutaneous coronary intervention (PCI) with TAXUS and Cardiac Surgery (SYNTAX) score is an angiographic tool which is used to determine the complexity of coronary artery disease (CAD). We aimed to compare PCI versus coronary artery bypass surgery (CABG) in patients with a high SYNTAX score in order to confirm with evidence whether the former is really association with worse clinical outcomes.Methods:The National database of medical research articles (MEDLINE/PubMed), EMBASE database, and the Cochrane library were searched for publications comparing PCI versus CABG in patients with a high SYNTAX score, respectively. Death, myocardial infarction (MI), stroke, repeated revascularization, and a combined outcome death/stroke/MI were considered as the clinical endpoints. RevMan software was used to analyze the data, whereby odds ratios (OR) with 95% confidence intervals (CI) were used as the statistical parameters.Results:A total number of 1074 patients were included (455 patients with a high SYNTAX score were classified in the PCI group and 619 other patients with a high SYNTAX score were classified in the CABG group). A SYNTAX score cut-off value of ≥33 was considered relevant. Compared with CABG, mortality was significantly higher with a high SYNTAX score following PCI with OR: 1.79, 95% CI: 1.18 to 2.70; P = .006, I2 = 0%. The combined outcome death/stroke/MI was also significantly higher following PCI with a high SYNTAX score, with OR: 1.69, 95% CI: 1.24 to 2.30; P = .0009, I2 = 0%. In addition, PCI was also associated with significantly higher MI and repeated revascularization when compared with CABG, with OR: 3.72, 95% CI: 1.75 to 7.89; P = .0006, I2 = 0% and OR: 4.33, 95% CI: 1.71 to 10.94; P = .002, I2 = 77%, respectively. However, stroke was not significantly different.Conclusions:Compared with CABG, worse clinical outcomes were observed following PCI in patients with a high SYNTAX score, confirming with evidence, published clinical literatures. Therefore, CABG should be recommended to CAD patients who have been allotted a high SYNTAX score.

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“…Similarly, a retrospective study has found that patients who had CABG recommended on the basis of a high SS but refused and chose PCI have an elevated risk of cardiac adverse events. [53] Even when the clinical SS is used to predict the best treatment approach, if patients with a high score refuse CABG in favor of PCI, subsequent outcomes have been found to be poorer.…”

Section: Advantages Of Cabg Vs Pcimentioning

confidence: 99%

The Clinical Value of Syntax Scores in Predicting Coronary Artery Disease Outcomes

Aşkın

2022

CVIA

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The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (SS) hassignificantly improved angiographic risk stratification. By analyzing angiographic variables, this score characterizescoronary artery disease qualitatively and quantitatively. To date, combining this score with other non-angiographic clinicalscores has broadened perspectives regarding risk estimation, and future research on this topic appears promising.

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Long-term outcomes of patients with complex coronary artery disease according to agreement between the SYNTAX score and revascularization procedure in contemporary practice

Cited by 4 publications

References 0 publications

Methods for assessing guideline adherence for invasive procedures in the care of chronic coronary artery disease: a scoping review

Methods for assessing guideline adherence for invasive procedures in the care of chronic coronary artery disease: a scoping review

Worse clinical outcomes following percutaneous coronary intervention with a high SYNTAX score

The Clinical Value of Syntax Scores in Predicting Coronary Artery Disease Outcomes

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