Related Experiment Videos

Risk profile and 3-year outcomes from the SYNTAX percutaneous coronary intervention and coronary artery bypass

Stuart J Head1, David R Holmes, Michael J Mack

  • 1Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.

JACC. Cardiovascular Interventions
|June 23, 2012
PubMed

Insights

Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were evaluated in patients unsuitable for the alternative. PCI patients had higher major adverse cardiac or cerebrovascular event (MACCE) rates than CABG patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Limited data exists on the risk profiles and outcomes for patients exclusively suited for PCI or CABG.
  • Real-world data is crucial for understanding treatment efficacy in specific patient subgroups.

Purpose of the Study:

  • To assess the real-world application and outcomes of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients for whom the alternative revascularization strategy was not suitable.
  • To evaluate the risk profile and major adverse cardiac or cerebrovascular event (MACCE) rates in these specific patient populations.

Main Methods:

  • The SYNTAX trial enrolled patients deemed suitable for either PCI or CABG, with a subset randomized if clinical equipoise existed.
  • Patients unsuitable for one procedure were assigned to a registry for the other (PCI-ineligible CABG registry or CABG-ineligible PCI registry).
  • Major adverse cardiac or cerebrovascular event (MACCE) rates were observed and reported as observational data.

Main Results:

  • A significant proportion of patients (6.4% for PCI, 35.0% for CABG) were treated in registries due to unsuitability for the alternative.
  • High-risk surgical patients undergoing PCI exhibited a 3-year MACCE rate of 38.0%, compared to 16.4% for patients undergoing CABG not suitable for PCI.
  • Increasing SYNTAX scores correlated with higher MACCE rates in both PCI and CABG registry groups.

Conclusions:

  • PCI and CABG remain essential treatment options for specific patient groups unable to undergo the alternative procedure.
  • Patients with major comorbidities deemed inoperable and treated with PCI experienced high MACCE rates.
  • Excellent surgical outcomes were observed in patients not suitable for PCI, highlighting the importance of CABG in specific complex cases.
Abstract

Related Concept Videos

Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches01:23

Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches

Biopharmaceutical studies constitute a vital field aiming to enhance drug delivery methods and refine therapeutic approaches, drawing upon diverse interdisciplinary knowledge. In research methodologies, the choice between controlled and non-controlled studies significantly influences the study's reliability and accuracy.
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast, controlled...
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Relative Risk01:12

Relative Risk

Relative risk (RR) is a statistical measure commonly used in epidemiology to compare the likelihood of a particular event occurring between two groups. This metric is important for evaluating the relationship between exposure to a specific risk factor and the probability of a particular outcome. It plays a crucial role in medical research, public health studies, and risk assessment. Relative risk quantifies how much more (or less) likely an event is to occur in an exposed group compared to an...
Coronary Artery Disease III: Clinical Manifestations01:30

Coronary Artery Disease III: Clinical Manifestations

Coronary Artery Disease (CAD) is a primary health risk worldwide, leading to significant morbidity and mortality. The condition arises from the buildup of atherosclerotic plaques within the coronary arteries, resulting in diminished blood supply to the heart muscle.The clinical manifestations of CAD vary widely, from asymptomatic stages to severe, life-threatening conditions. Understanding these manifestations is crucial for early diagnosis and effective management.Angina Pectoris: The Warning...