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

C oronary artery bypass graft (CABG) surgery has been the standard of care for coronary revascularization. However, during long-term follow-up after initial CABG surgery, patients are at risk of subsequent ischemia because of late graft failures and degeneration of native coronary arteries.2 Regarding repeat coronary revascularization in previous CABG surgery cases, in particular for late failure of saphenous vein grafts, the number of patients referred for percutaneous coronary intervention (PCI) has been increasing. 2,3However, in patients with previous CABG surgery, the optimal revascularization strategy and risk stratification are not yet fully known. 4,5Background-The efficacy and prognosis of percutaneous coronary intervention (PCI) as secondary revascularization in patients with previous coronary artery bypass graft surgery remain uncertain. Methods and Results-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. Conclusions-In this external validation study, the CSS was a potential prognostic factor after subsequent PCI, even for previous coronary artery bypass graft surgery patients. (Circ Cardiovasc Interv. 2016;9:e003459.

Three-dimensional assessment of coronary high-intensity plaques with T1-weighted cardiovascular magnetic resonance imaging to predict periprocedural myocardial injury after elective percutaneous coronary intervention

“…PCI was performed as previously reported [16]. pMI after elective PCI was defined as an increase in serum hs-cTnT levels to more than 5 times the upper limit of normal (0.07 ng/ Fig.…”

Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement

“…Those patients without angiograms for review were categorized based on documentation of coronary anatomy. When films were available, we performed either baseline SYNTAX scoring (SS) or CABG SYNTAX scoring (CSS) . The rSS is reflective of the degree of pre‐TAVR atherosclerotic burden, taking into account any preceding PCI in anticipation of TAVR .…”

Comparison of Long-Term Mortality in Patients With Previous Coronary Artery Bypass Grafting Who Underwent Percutaneous Coronary Intervention With Versus Without Optimal Medical Therapy

“…PCI procedures were performed using standard preparations and techniques, as reported previously. 3 Procedural and technical preferences were left to the discretion of the operators. The recommended antiplatelet regimen after PCI consisted of aspirin (81 to 100 mg/day) indefinitely and a thienopyridine (ticlopidine 200 mg or clopidogrel 75 mg/ day) for at least 12 months after drug-eluting stent implantation or at least 3 months after bare-metal stent implantation.…”

“…The recommended antiplatelet regimen after PCI consisted of aspirin (81 to 100 mg/day) indefinitely and a thienopyridine (ticlopidine 200 mg or clopidogrel 75 mg/ day) for at least 12 months after drug-eluting stent implantation or at least 3 months after bare-metal stent implantation. 3 Follow-up information was obtained via telephone interview (n = 38), answers to questionnaires were obtained by mail (n = 83), and outpatient medical records were obtained from the hospital's databases (n = 487). Clinical follow-up was performed from December 1, 2016, to May 31, 2017.…”

“…Hypertension and diabetes mellitus were defined as described previously. 3 Hyperlipidemia was defined as a fasting total cholesterol level of ≥220 mg/dL, a low-density lipoprotein cholesterol level of ≥140 mg/dL, or being on hyperlipidemia therapy. 5 Chronic kidney disease was defined as an estimated glomerular filtration rate of <60 ml/min/1.73 m 2 or being on hemodialysis.…”