Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Atif Mohammad, M.D.
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Related Key Words and Synonyms:
SYNTAX, Taxus, Drug Eluting Stents, SYNTAX Score, SYNTAX trial, CABG, Coronary artery bypass graft, PCI, Angioplasty
Overview
SYNTAX which is the abbreviation for "Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery" was a prospective clinical trial conducted in 85 sites in 17 countries across Europe and the United States.The purpose of this study was to assess objective revascularization strategy and treatment protocol for patients with previously untreated 3-vessel disease or left main coronary artery disease and identify the populations for whom only one will be better.Previous clinical trials comparing bare metal stents with CABG have shown similar survival rates but higher revascularization rates in patients having bare metal stents. Randomized clinical trials have also shown Drug Eluting Stents (DES)as compared with Bare Metal Stents (BMS), to show better results in terms of repeat revascularization, myocardial infarction and deaths especially in more complex anatomical cases .Currently, the guidelines for 3 vessel disease or left main is the patient to go for bypass surgery.[1]The SYNTAX trial was conducted to assess the efficacy of Taxus which is a Paclitaxel coated drug eluting stent as compared to CABG for effective means of revascularization in patients with three vessel disease or left main disease.
Methods of Study
1800 patients were enrolled in the study.An interventional cardiologist and Cardiac surgeon both assessed patients eligible for the study according to the study criteria.[2]Patients which were determined to have equivalent results with either CABG or PCI were randomly assigned to either arm.Patients for whom one treatment was effective were assigned to parallel registry-PCI registry for CABG ineligible patients and likewise CABG registry for PCI ineligible patients.
SYNTAX Score
Diagnostic angiograms and electrocardiograms were individually assessed by staff at an independent site who were unaware of treatment status of patients.A SYNTAX Score was designed for scoring of the coronary angiograms according to their severity of disease.[3]The SYNTAX score was used as a diagnostic tool for comprehensive anatomical assessment of patients with coronary artery disease .Higher scores reflect more complex disease and lower scores less severe.Patients with left main disease with 1 or 2 vessel disease had higher scores as compared to 3-vessel disease.A high score was considered > 33 and a low score was defined as < 22.[4]
Table 1-Individual Segment Scoring System of Coronary Arterial Tree[5]
| Segment No | Segment | Right Dominance Score | Left Dominance Score |
| 1 | RCA Proximal | 1 | 0 |
| 2 | RCA Mid | 1 | 0 |
| 3 | RCA Distal | 1 | 0 |
| 4 | Posterior Descending Artery | 1 | n.a. |
| 16 | Postero-lateral branch from RCA | 0.5 | n.a. |
| 16a | Postero-lateral branch from RCA | 0.5 | n.a. |
| 16b | Postero-lateral branch from RCA | 0.5 | n.a. |
| 16c | Postero-lateral branch from RCA | 0.5 | n.a. |
| 5 | Left Main | 5 | 6 |
| 6 | LAD Proximal | 3.5 | 2.5 |
| 7 | LAD Mid | 2.5 | 2.5 |
| 8 | LAD Apical | 1 | 1 |
| 9 | First Diagonal | 1 | 1 |
| 9a | First Diagonal a | 1 | 1 |
| 10 | Second Diagonal | 0.5 | 0.5 |
| 10a | Second Diagonal a | 0.5 | 0.5 |
| 11 | Proximal Circumflex Artery | 1.5 | 2.5 |
| 12 | Intermediate/anterolateral artery | 1 | 1 |
| 12a | Obtuse marginal a | 1 | 1 |
| 12b | Obtuse marginal b | 1 | 1 |
| 13 | Distal Cicumflex | 0.5 | 1.5 |
| 14 | Left Posterolateral | 0.5 | 1 |
| 14a | Left Posterolateral a | 0.5 | 1 |
| 14b | Left Posterolateral b | 0.5 | 1 |
| 15 | Posterior Descending Artery | n.a. | 1 |
- ↑ Eagle KA, Guyton RA, Davidoff R; et al. (2004). "ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery)". Circulation. 110 (14): e340–437. PMID 15466654. Unknown parameter
|month=ignored (help) - ↑ "SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries - Full Text View - ClinicalTrials.gov".
- ↑ "SYNTAX Score".
- ↑ Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Ståhle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW (2009). "Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease". N. Engl. J. Med. 360 (10): 961–72. doi:10.1056/NEJMoa0804626. PMID 19228612. Unknown parameter
|month=ignored (help) - ↑ Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, van den Brand M, Van Dyck N, Russell ME, Mohr FW, Serruys PW (2005). "The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease". EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 1 (2): 219–27. PMID 19758907. Unknown parameter
|month=ignored (help)