Complex coronary anatomy in coronary artery bypass graft surgery: Impact of complex coronary anatomy in modern bypass surgery? Lessons learned from the SYNTAX trial after two years
Read at the 90th Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, May 1–5, 2010.
SYNTAX study compares outcomes of coronary artery bypass grafting with percutaneous coronary intervention in patients with 3-vessel and/or left main disease. Complexity of coronary artery disease was quantified by the SYNTAX score, which combines anatomic characteristics of each significant lesion. This study aims to clarify whether SYNTAX score affects the outcome of bypass grafting as defined by major adverse cerebrovascular and cardiac events (MACCE) and its components over a 2-year follow-up period.
Methods
Of the 3075 patients enrolled in SYNTAX, 1541 underwent coronary artery bypass grafting (897 randomized controlled trial patients, and 644 registry patients). All patients undergoing bypass grafting were stratified according to their SYNTAX score into 3 tertiles: low (0–22), intermediate (22–32), and high (≥33) complexity. Clinical outcomes up to 2 years after allocation were determined for each group and further risk factor analysis was performed.
Results
Registry patients had more complex disease than those in the randomized controlled trial (SYNTAX score: registry 37.8 ± 13.3 vs randomized 29.1 ± 11.4; P < .001). At 30 days, overall coronary bypass mortality was 0.9% (registry 0.6% vs randomized 1.2%). MACCE rate at 30 days was 4.4% (registry 3.4% vs randomized 5.2%).
SYNTAX score did not significantly affect overall 2-year MACCE rate of 15.6% for low, 14.3% for medium, and 15.4% for high SYNTAX scores. Compared with randomized patients, registry patients had a lower rate of overall MACCE rate (registry 13.0% vs randomized 16.7%; P = .046) and repeat revascularization (4.7% vs 8.6%; P = .003), whereas other event rates were comparable. Risk factor analysis revealed left main disease (P = .049) and incomplete revascularization (P = .005) as predictive for adverse 2-year outcomes.
Conclusions
The outcome of coronary artery bypass grafting was excellent and independent from the SYNTAX score. Incomplete revascularization rather than degree of coronary complexity adversely affects late outcomes of coronary bypass.
CTSNet classification
23.1
Abbreviations and Acronyms
CABG
coronary artery bypass grafting
CVA
cerebrovascular accident
ITA
internal thoracic artery
LAD
left anterior descending coronary artery
LM
left main
MACCE
major adverse cardiac and cerebrovascular event
MI
myocardial infarction
OUS
outside the United States
PCI
percutaneous coronary intervention
SYNTAX
SYNergy between PCI with TAXUS and Cardiac Surgery
US
United States
VD
vessel disease
Cited by (0)
Supported by Boston Scientific Corporation Clinical Trial Registration Information: NCT00114972.
Disclosures: Friedrich W. Mohr and Patrick W. Serruys were the SYNTAX study principal investigators and A. Pieter Kappetein was co-principal investigator. Dr. Kappetein reports receiving consulting and lecture fees from Boston Scientific. Katrin Leadley and Keith Dawkins are full-time employees of Boston Scientific and receive a salary and hold equity in the company. All other authors were site investigators and have no other conflicts of interest. This study was supported by Boston Scientific, but the company was not involved in the decision to publish the results of the study. All authors have participated in the interpretation of the data, drafting and review of this manuscript, and have approved its submission.
