Coronary interventions

Clinical outcomes of state-of-the-art percutaneous coronary revascularisation in patients with three-vessel disease: two-year follow-up of the SYNTAX II study

EuroIntervention 2019;15:e244-e252. DOI: 10.4244/EIJ-D-18-00980

Patrick Serruys
Patrick W. Serruys1,2, MD, PhD; Norihiro Kogame3, MD; Yuki Katagiri3, MD; Rodrigo Modolo3, MD; Pawel E. Buszman4,5, MD, PhD; Andrés Íñiguez-Romo6, MD, PhD; Javier Goicolea7, MD, PhD; David Hildick-Smith8, MD; Andrzej Ochala5, MD, PhD; Dariusz Dudek9, MD, PhD; Jan J. Piek3, MD, PhD; Joanna J. Wykrzykowska3, MD, PhD; Javier Escaned10, MD, PhD; Adrian P. Banning11, MBBS, MD; Vasim Farooq12, MBChB, PhD; Yoshinobu Onuma2, MD, PhD
1. Imperial College London, London, United Kingdom; 2. ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands; 3. Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands; 4. Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland; 5. Medical University of Silesia, Katowice, Poland; 6. Department of Cardiology, Hospital Meixoeiro, Pontevedra, Spain; 7. Department of Cardiology, Hospital Puerta de Hierro, Madrid, Spain; 8. Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom; 9. Institute of Cardiology, Jagiellonian University, Krakow, Poland; 10. Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain; 11. Department of Cardiology, John Radcliffe Hospital, Cardiology, Oxford, United Kingdom; 12. The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom

Aims: The purpose of the study was to investigate whether the favourable outcomes of state-of-the-art PCI in the SYNTAX II trial, demonstrated at one year, were maintained at two-year follow-up.

Methods and results: The SYNTAX II study was a multicentre, single-arm study that investigated the impact of a contemporary PCI strategy on clinical outcomes in 454 patients with de novo three-vessel coronary artery disease, without left main disease. Clinical outcomes in SYNTAX II were compared to the predefined PCI (SYNTAX-I PCI) and coronary artery bypass graft (SYNTAX-I CABG) cohorts from the landmark SYNTAX trial (SYNTAX-I), selected on the basis of equipoise for long-term (four-year) mortality utilising the SYNTAX score II. At two years, major adverse cardiac and cerebrovascular events (MACCE: a composite of all-cause death, any stroke, myocardial infarction, or revascularisation) in SYNTAX II were significantly lower compared to SYNTAX-I PCI (13.2% vs. 21.9%, p=0.001). Furthermore, similar two-year outcomes for MACCE were evident between SYNTAX II PCI and SYNTAX-I CABG (13.2% vs. 15.1%, p=0.42).

Conclusions: At two years, clinical outcomes with the SYNTAX II strategy remained superior to the predefined SYNTAX-I PCI cohort, and similar to the predefined SYNTAX-I CABG cohort.

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