SYNTAX is unhelpful in patients with DM, multivessel CAD

  • J Am Coll Cardiol

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • SYNTAX score should not be used to guide coronary revascularization choice in patients with diabetes mellitus (DM) and multivessel coronary artery disease (CAD).

Why this matters

  • Diabetes is associated with complex CAD and increased cardiovascular morbidity/mortality.

Study design

  • Trial randomly assigned 1900 patients with diabetes and multivessel CAD to percutaneous coronary intervention (PCI) with drug-eluting stents or coronary artery bypass grafting (CABG).
  • Hard cardiovascular events (HCE) endpoint was composite of death from any cause, nonfatal myocardial infarction, and nonfatal stroke.
  • Major adverse cardiac and cerebrovascular events (MACCE) were composite of HCE and repeat revascularization.
  • Funding: NIH.

Key results

  • In the PCI group, significant difference in MACCE (P=.04) and nonsignificant difference for HCE (P=.07) between SYNTAX categories.
  • SYNTAX score independently predicted HCE at 5 years in PCI group (HR per SYNTAX unit: 1.03; P=.002).
  • In CABG group, no difference in cardiovascular events between SYNTAX categories at 5-year follow-up.
  • Higher MACCE incidence in PCI patients with low, intermediate, and high SYNTAX scores compared with CABG group (36.6% vs 25.9% with low SYNTAX category [P=.02]; 43.9% vs 26.8% with intermediate SYNTAX [P<.001 vs with high syntax>

Limitations

  • Not powered for comparisons between SYNTAX subgroups overall or individual MACCE components.

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