Circ Cardiovasc Interv

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Circ Cardiovasc Interv 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 by Tadayoshi Miyagi, Yasuhide Asaumi, Kunihiro Nishimura, Takahiro Nakashima, Hiroki Sakamoto, Kazuhiro Nakao, Tomoaki Kanaya, Toshiyuki Nagai, Yuji Shimabukuro, Yoshihiro Miyamoto, Tomoyuki Fujita, Kengo Kusano, Toshihisa Anzai, Junjirou Kobayashi, Teruo Noguchi, Hisao Ogawa, and Satoshi Yasuda Circ Cardiovasc Interv Volume 9(9):e003459 August 30, 2016 Copyright © American Heart Association, Inc. All rights reserved.

Flow chart of study patients. Flow chart of study patients. CABG indicates coronary artery bypass grafting; CSS, CABG SYNTAX score (Synergy Between Percutaneous Coronary Intervention With Taxus); PCI, percutaneous coronary intervention; and SYNTAX, Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery. Tadayoshi Miyagi et al. Circ Cardiovasc Interv. 2016;9:e003459 Copyright © American Heart Association, Inc. All rights reserved.

Representative cases with previous coronary artery bypass graft (CABG) surgery who underwent percutaneous coronary intervention (PCI) and CABG SYNTAX score (Synergy Between Percutaneous Coronary Intervention With Taxus) measures. Representative cases with previous coronary artery bypass graft (CABG) surgery who underwent percutaneous coronary intervention (PCI) and CABG SYNTAX score (Synergy Between Percutaneous Coronary Intervention With Taxus) measures. The baseline CSS was calculated to identify all coronary lesions both at baseline and during coronary angiogram. The post-PCI CSS was calculated based on the remaining obstructive coronary disease following PCI. A, Case 1: A 76-y-old man with 3-vessel disease, including proximal occlusion of the left anterior descending artery (LAD), who underwent CABG surgery. Coronary angiography showed a patent bypass graft from the left internal thoracic artery (LITA) to the LAD (a), total occlusion at the left main trunk (LMT) and proximal right coronary artery (RCA, b and c), and proximal stenosis from the saphenous vein graft (SVG) to the posterolateral artery (PL; d; white arrow). PCI was performed on the proximal SVG-to-PL lesion (e; white arrowhead). The baseline CSS was calculated to be 41. After PCI, the post-PCI CSS was 38. B, Case 2: A 63-y-old man with 3-vessel disease who underwent CABG surgery. Coronary angiography showed a patent bypass graft from the LITA to the LAD (f), severe stenosis at the distal LMT bifurcation and mid circumflex artery (LCX) (g; yellow arrows), and total occlusion at the proximal RCA (h). The baseline CSS (panels f, g, and h) was 45. After stent implantations from the LMT to proximal LCX and at the mid-LCX lesions (panel i; yellow arrowheads), the post-PCI CSS was 20. Tadayoshi Miyagi et al. Circ Cardiovasc Interv. 2016;9:e003459 Copyright © American Heart Association, Inc. All rights reserved.

Distribution of baseline CABG (coronary artery bypass graft) SYNTAX score (Synergy Between Percutaneous Coronary Intervention With Taxus) (A) and post–percutaneous coronary intervention (PCI) CSS after PCI (B) and scatter plots to visualize the relationship between these 2 factors (C; baseline CSS for x axis and post-PCI CSS for y axis) in 434 patients with previous coronary atery bypass grafting surgery. Distribution of baseline CABG (coronary artery bypass graft) SYNTAX score (Synergy Between Percutaneous Coronary Intervention With Taxus) (A) and post–percutaneous coronary intervention (PCI) CSS after PCI (B) and scatter plots to visualize the relationship between these 2 factors (C; baseline CSS for x axis and post-PCI CSS for y axis) in 434 patients with previous coronary atery bypass grafting surgery. Tadayoshi Miyagi et al. Circ Cardiovasc Interv. 2016;9:e003459 Copyright © American Heart Association, Inc. All rights reserved.

Kaplan–Meier analysis of cumulative rates of composite major adverse cardiac events (MACE; A), cardiac death (B), all-cause death (C), and any revascularization (D) in 2 patient groups based on post–percutaneous coronary intervention (PCI) CABG (coronary artery bypass graft) SYNTAX score (Synergy Between Percutaneous Coronary Intervention With Taxus) (CCS). Kaplan–Meier analysis of cumulative rates of composite major adverse cardiac events (MACE; A), cardiac death (B), all-cause death (C), and any revascularization (D) in 2 patient groups based on post–percutaneous coronary intervention (PCI) CABG (coronary artery bypass graft) SYNTAX score (Synergy Between Percutaneous Coronary Intervention With Taxus) (CCS). Patients were divided by median post-PCI CSS: low (≤23, n=217) and high (>23, n=217). MACE include cardiovascular death, myocardial infarction, and unplanned revascularization. Tadayoshi Miyagi et al. Circ Cardiovasc Interv. 2016;9:e003459 Copyright © American Heart Association, Inc. All rights reserved.

Clinical outcomes, according to subgroup. Clinical outcomes, according to subgroup. Subgroup analyses of post–percutaneous coronary intervention (PCI) CABG (coronary artery bypass graft) SYNTAX score (Synergy Between Percutaneous Coronary Intervention With Taxus) were performed with the use of Cox proportional hazards regression. Five-y composite events rates for cardiovascular death, myocardial infarction, and urgent revascularization (A), cardiac death (B), all-cause death (C), and any revascularization (D) are shown. Hazard ratios (HR) with 95% confidence intervals (95% CI) are shown. CKD indicates chronic kidney disease; DM, diabetes mellitus; LVEF, left ventricular ejection fraction; and MACE, major adverse cardiac events. Tadayoshi Miyagi et al. Circ Cardiovasc Interv. 2016;9:e003459 Copyright © American Heart Association, Inc. All rights reserved.