In patients undergoing percutaneous coronary intervention (PCI) who have diabetes and multivessel disease, a validated prediction score used to estimate risk with PCI is modestly correlated with hard cardiovascular events and is significantly correlated with major adverse cardiac and cerebrovascular events (MACCE), according to study findings published in the Journal of the American College of Cardiology.
The Synergy Between PCI With TAXUS and Cardiac Surgery (SYNTAX) score uses coronary anatomy to objectively guide decisions about revascularization. Studies have confirmed its clinical validity for identifying high-risk patients and its use when making decisions regarding coronary artery bypass grafting and PCI. In this study, researchers evaluated the use of SYNTAX score to predict future cardiovascular events in a patient population with diabetes and complex coronary artery disease (CAD) who were undergoing coronary artery bypass grafting or PCI.
The FREEDOM (Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease) trial studied patients with diabetes with native, multivessel CAD who were randomly assigned to either PCI with drug-eluting stents or coronary artery bypass grafting. In the current study, 1900 patients from the FREEDOM trial were followed prospectively; 953 patients underwent PCI and 947 patients had coronary artery bypass grafting. SYNTAX scores were calculated retrospectively for each patient. Hard cardiovascular events were defined as a composite of death from any cause, nonfatal myocardial infarction, and nonfatal stroke. MACCE were defined as was a composite of a hard cardiovascular event and need for repeat revascularization.
SYNTAX score appeared to be an independent predictor of 5-year MACCE (hazard ratio per unit of SYNTAX score, 1.02; 95% CI, 1.00-1.03; P =.014) and hard cardiovascular events (hazard ratio per unit of SYNTAX score, 1.03; 95% CI, 1.01-1.04; P =.002) among patients who received PCI, but not in the coronary artery bypass grafting arm. A higher incidence of MACCE was observed in those who underwent PCI and had low, intermediate, and high SYNTAX score vs those who underwent coronary artery bypass grafting (36.6% vs 25.9%, P =.02; 43.9% vs 26.8%, P <.001; 48.7% vs. 29.7%, P =.003, respectively).
“Our findings highlight the importance of anatomic and clinical evaluation of [patients with diabetes] with CAD,” concluded the researchers. “The decision-making of the best strategy for revascularization should consider not only coronary angiographic aspects but also clinical aspects that could influence the outcomes. The [SYNTAX score] alone should not be utilized to guide the choice of coronary revascularization in patients with [diabetes] and multivessel CAD.”
Esper RB, Farkouh ME, Ribeiro EE, et al. SYNTAX score in patients with diabetes undergoing coronary revascularization in the FREEDOM trial. J Am Coll Cardiol. 2018;72(23):2826-2837.