Author + information
- Received April 2, 2018
- Revision received June 17, 2018
- Accepted June 20, 2018
- Published online September 10, 2018.
- Yuhei Kobayashi, MDa,
- Jacob Lønborg, MDb,
- Andy Jong, MDc,
- Takeshi Nishi, MD, PhDa,
- Bernard De Bruyne, MD, PhDd,
- Dan Eik Høfsten, MD, PhDb,
- Henning Kelbæk, MDb,
- Jamie Layland, MDc,
- Chang-Wook Nam, MDe,
- Nico H.J. Pijls, MD, PhDf,
- Pim A.L. Tonino, MD, PhDf,
- Julie Warnøe, MDb,
- Keith G. Oldroyd, MDc,
- Colin Berry, MDc,g,
- Thomas Engstrøm, MDb,
- William F. Fearon, MDa,∗ (, )@StanfordMed,
- on behalf of the DANAMI-3-PRIMULTI, FAME, and FAMOUS-NSTEMI Study Investigators
- aDivision of Cardiovascular Medicine, Stanford University Medical Center and Stanford Cardiovascular Institute, Stanford, California
- bDepartment of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- cWest of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, United Kingdom
- dCardiovascular Center Aalst, Aalst, Belgium
- eKeimyung University College of Medicine, Dongsan Medical Center, Daegu, South Korea
- fCatharina Hospital, Heartcenter, Eindhoven, the Netherlands
- gBritish Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
- ↵∗Address for correspondence:
Dr. William F. Fearon, Division of Cardiovascular Medicine, Stanford University Medical Center, 300 Pasteur Drive, H2103, Stanford, California 94305-5218.
Background The residual SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (RSS) quantitatively assesses angiographic completeness of revascularization after percutaneous coronary intervention (PCI) and has been shown to be a predictor of events after angiography-guided PCI. In stable patients undergoing functionally complete revascularization with fractional flow reserve (FFR) guidance, RSS did not predict outcome. Whether this is also true in patients with acute coronary syndromes (ACS) is unknown.
Objectives The purpose of this study was to determine whether the RSS could predict outcomes in patients with ACS.
Methods From the DANAMI-3-PRIMULTI (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation), and FAMOUS-NSTEMI (Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes) trials, 547 patients presented with ACS and underwent functionally complete revascularization. Major adverse cardiac events (MACE) were defined as the composite endpoint of all-cause death, nonfatal myocardial infarction, and any repeat revascularization. The RSS was based on the recalculation of the SYNTAX score after PCI. We compared differences in 2-year outcome by the RSS subgroups: 0, 1 to <5, 5 to <10, ≥10 (RSS = 0 represents angiographically complete revascularization).
Results The study population consisted of 271 patients with unstable angina/non–ST-segment elevation myocardial infarction and 276 with ST-segment elevation myocardial infarction. The mean RSS was 6.7 ± 5.8. MACE at 2 years occurred in 69 patients (12.6%). Patients with and without MACE had similar RSS after PCI (RSS: 7.2 ± 5.5 vs. 6.6 ± 5.9; p = 0.23). Kaplan-Meier curve analysis showed a similar incidence of MACE regardless of the RSS subgroups (p = 0.54). With and without adjustment of clinical variables, RSS was not a significant predictor of MACE or of each component of MACE.
Conclusions After complete revascularization of functionally significant stenosis by FFR, the extent of residual angiographic disease is not associated with subsequent ischemic events in patients presenting with ACS. These results suggest that the concept of functionally complete revascularization is applicable even in ACS patients. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [F.A.M.E.] NCT00267774; Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes [FAMOUS NSTEMI] NCT01764334; Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [DANAMI-3-PRIMULTI]; NCT01960933)
The DANAMI-3-PRIMULTI trial was funded by the Danish Agency for Science, Technology and Innovation, and the Danish Council for Strategic Research (EDITORS, grant 09-066994). The FAME study was sponsored by St. Jude Medical (now Abbott). The FAMOUS-NSTEMI study was supported by grants from the British Heart Foundation (RE/13/5/30177 and PG/11/55/28999), and St. Jude Medical (now Abbott) provided the pressure wires. Dr. De Bruyne has received institutional consultancy fees and research support from Abbott/St. Jude Medical, Boston Scientific, Biotronik, and Opsens; and has equities in Siemens, Bayer, Philips, GE, HeartFlow, Edwards Lifesciences, Sanofi, and Celyad. Dr. Layland has served in an advisory role for Medtronic. Dr. Nam has received institutional research support from Pfizer, Medtronic, and Biosensors; and has served as a consultant for Pfizer, Abbott Vascular, and Boehringer Ingelheim. Dr. Pijls has received institutional grant support from Abbott/St. Jude Medical; has served as a consultant for Abbott/St. Jude Medical and Opsens; and possesses equity in Philips, GE, ASML, and HeartFlow. Dr. Oldroyd has received speaker fees from Abbott Vascular. Dr. Berry has received institutional research grant support and served as a consultant for Abbott/St. Jude Medical; and his institution holds research and consultancy agreements with companies with interests in interventional cardiology, including Abbott Vascular, Coroventis, and Opsens. Dr. Engstrøm has received speaker fees from AstraZeneca, Boston Scientific, and Abbott; has served as consultant for Novo Nordisk; and has received advisory board fees from Bayer AS. Dr. Fearon has received institutional research support from Abbott, Medtronic, and CathWorks; has a consulting relationship with Boston Scientific; and has minor stock options with HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 2, 2018.
- Revision received June 17, 2018.
- Accepted June 20, 2018.
- 2018 American College of Cardiology Foundation
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