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SYNTAX Score in Patients With Diabetes Undergoing Coronary Revascularization in the FREEDOM Trial.
J Am Coll Cardiol 2018; 72(23 Pt A):2826-2837JACC

Abstract

BACKGROUND

Diabetes mellitus (DM) is associated with complex coronary artery disease (CAD), which in turn results in increased morbidity and mortality from cardiovascular disease.

OBJECTIVES

This study sought to evaluate the utility of SYNTAX score (SS) for predicting future cardiovascular events in patients with DM and complex CAD undergoing either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).

METHODS

The FREEDOM (Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease) trial randomized patients with DM and multivessel CAD to undergo either PCI with drug-eluting stents or CABG. The SS was calculated retrospectively by a core laboratory. The endpoint of hard cardiovascular events (HCE) was a composite of death from any cause, nonfatal myocardial infarction, and nonfatal stroke, while the endpoint of major adverse cardiac and cerebrovascular events (MACCE) was a composite of HCE and repeat revascularization.

RESULTS

A total of 1,900 patients were randomized to PCI (n = 953) or CABG (n = 947). The SS was considered an independent predictor of 5-year MACCE (hazard ratio per unit of SS: 1.02; 95% confidence interval: 1.00 to 1.03; p = 0.014) and HCE (hazard ratio per unit of SS: 1.03; 95% confidence interval: 1.01 to 1.04; p = 0.002) in the PCI cohort, but not in the CABG group. There was a higher incidence of MACCE in PCI patients with low, intermediate, and high SS compared with those who underwent CABG (36.6% vs. 25.9%, p = 0.02; 43.9% vs. 26.8%, p < 0.001; 48.7% vs. 29.7%, p = 0.003, respectively).

CONCLUSIONS

In DM patients with multivessel CAD, the complexity of CAD evaluated by the SS is an independent risk factor for MACCE and HCE only in patients undergoing PCI. The SS should not be utilized to guide the choice of coronary revascularization in patients with DM and multivessel CAD. (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450).

Authors+Show Affiliations

Heart Institute of the University of São Paulo Medical School, São Paulo, Brazil; Prevent Senior Institute, São Paulo, Brazil.Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: michael.farkouh@uhn.ca.Heart Institute of the University of São Paulo Medical School, São Paulo, Brazil.Heart Institute of the University of São Paulo Medical School, São Paulo, Brazil.Department of Medicine, Mount Sinai Medical Center, New York, New York.New England Research Institutes, Watertown, Massachusetts.New England Research Institutes, Watertown, Massachusetts.Heart Institute of the University of São Paulo Medical School, São Paulo, Brazil; Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada.Division of Cardiology, Loyola University Stritch School of Medicine, Maywood, Illinois.Department of Cardiology, University of New South Wales, Liverpool Hospital, Sydney, New South Wales, Australia.Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30522646

Citation

Esper, Rodrigo B., et al. "SYNTAX Score in Patients With Diabetes Undergoing Coronary Revascularization in the FREEDOM Trial." Journal of the American College of Cardiology, vol. 72, no. 23 Pt A, 2018, pp. 2826-2837.
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 Pt A):2826-2837.
Esper, R. B., Farkouh, M. E., Ribeiro, E. E., Hueb, W., Domanski, M., Hamza, T. H., ... Fuster, V. (2018). SYNTAX Score in Patients With Diabetes Undergoing Coronary Revascularization in the FREEDOM Trial. Journal of the American College of Cardiology, 72(23 Pt A), pp. 2826-2837. doi:10.1016/j.jacc.2018.09.046.
Esper RB, et al. SYNTAX Score in Patients With Diabetes Undergoing Coronary Revascularization in the FREEDOM Trial. J Am Coll Cardiol. 2018 12 11;72(23 Pt A):2826-2837. PubMed PMID: 30522646.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - SYNTAX Score in Patients With Diabetes Undergoing Coronary Revascularization in the FREEDOM Trial. AU - Esper,Rodrigo B, AU - Farkouh,Michael E, AU - Ribeiro,Expedito E, AU - Hueb,Whady, AU - Domanski,Michael, AU - Hamza,Taye H, AU - Siami,Flora S, AU - Godoy,Lucas Colombo, AU - Mathew,Verghese, AU - French,John, AU - Fuster,Valentin, PY - 2018/07/30/received PY - 2018/09/13/revised PY - 2018/09/14/accepted PY - 2018/12/8/entrez PY - 2018/12/14/pubmed PY - 2019/9/12/medline KW - CABG KW - PCI KW - SYNTAX score KW - coronary artery disease KW - diabetes SP - 2826 EP - 2837 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 72 IS - 23 Pt A N2 - BACKGROUND: Diabetes mellitus (DM) is associated with complex coronary artery disease (CAD), which in turn results in increased morbidity and mortality from cardiovascular disease. OBJECTIVES: This study sought to evaluate the utility of SYNTAX score (SS) for predicting future cardiovascular events in patients with DM and complex CAD undergoing either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). METHODS: The FREEDOM (Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease) trial randomized patients with DM and multivessel CAD to undergo either PCI with drug-eluting stents or CABG. The SS was calculated retrospectively by a core laboratory. The endpoint of hard cardiovascular events (HCE) was a composite of death from any cause, nonfatal myocardial infarction, and nonfatal stroke, while the endpoint of major adverse cardiac and cerebrovascular events (MACCE) was a composite of HCE and repeat revascularization. RESULTS: A total of 1,900 patients were randomized to PCI (n = 953) or CABG (n = 947). The SS was considered an independent predictor of 5-year MACCE (hazard ratio per unit of SS: 1.02; 95% confidence interval: 1.00 to 1.03; p = 0.014) and HCE (hazard ratio per unit of SS: 1.03; 95% confidence interval: 1.01 to 1.04; p = 0.002) in the PCI cohort, but not in the CABG group. There was a higher incidence of MACCE in PCI patients with low, intermediate, and high SS compared with those who underwent CABG (36.6% vs. 25.9%, p = 0.02; 43.9% vs. 26.8%, p < 0.001; 48.7% vs. 29.7%, p = 0.003, respectively). CONCLUSIONS: In DM patients with multivessel CAD, the complexity of CAD evaluated by the SS is an independent risk factor for MACCE and HCE only in patients undergoing PCI. The SS should not be utilized to guide the choice of coronary revascularization in patients with DM and multivessel CAD. (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450). SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/30522646/SYNTAX_Score_in_Patients_With_Diabetes_Undergoing_Coronary_Revascularization_in_the_FREEDOM_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(18)38690-X DB - PRIME DP - Unbound Medicine ER -