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Mis-estimation of coronary lesions and rectification by SYNTAX score feedback for coronary revascularization appropriateness.
Lin, Shen; Zhang, Heng; Chen, Si-Peng; Rao, Chen-Fei; Wu, Fan; Zhou, Fa-Jun; Wang, Yun; Yan, Hong-Bing; Dou, Ke-Fei; Wu, Yong-Jian; Tang, Yi-Da; Xie, Li-Hua; Guan, Chang-Dong; Xu, Bo; Zheng, Zhe.
Affiliation
  • Lin S; National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
  • Zhang H; National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
  • Chen SP; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
  • Rao CF; Department of Information Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
  • Wu F; National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
  • Zhou FJ; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
  • Wang Y; National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
  • Yan HB; Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
  • Dou KF; National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
  • Wu YJ; Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
  • Tang YD; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Xie LH; Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, CT, USA.
  • Guan CD; National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
  • Xu B; Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
  • Zheng Z; National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China.
Chin Med J (Engl) ; 133(11): 1276-1284, 2020 Jun 05.
Article in En | MEDLINE | ID: mdl-32452896
ABSTRACT

BACKGROUND:

Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization. Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a comprehensive system to evaluate the complexity of the overall lesions. We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease (CAD).

METHODS:

In this single-center, historical control study, patients with stable CAD with coronary lesion stenosis ≥50% were consecutively recruited. During the control period, SYNTAX scores were calculated by treating cardiologists. During the intervention period, SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making. The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.

RESULTS:

A total of 3245 patients were enrolled and assigned to the control group (08/2016-03/2017, n = 1525) or the intervention group (03/2017-09/2017, n = 1720). For SYNTAX score tertiles, 17.9% patients were overestimated and 4.3% were underestimated by cardiologists in the control group. After adjustment, inappropriate revascularization significantly decreased in the intervention group compared with the control group (adjusted odds ratio [OR] 0.83; 95% confidence interval [CI] 0.73-0.95; P = 0.007). Both inappropriate percutaneous coronary intervention (adjusted OR 0.82; 95% CI 0.74-0.92; P < 0.001) and percutaneous coronary intervention utilization (adjusted OR 0.88; 95% CI 0.79-0.98; P = 0.016) decreased significantly in the intervention group. There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.

CONCLUSIONS:

Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD. CLINICAL TRIAL REGISTRATION Nos. NCT03068858 and NCT02880605; https//www.clinicaltrials.gov.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Coronary Artery Disease / Drug-Eluting Stents / Percutaneous Coronary Intervention Type of study: Clinical_trials / Etiology_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Chin Med J (Engl) Year: 2020 Document type: Article Affiliation country: China

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Coronary Artery Disease / Drug-Eluting Stents / Percutaneous Coronary Intervention Type of study: Clinical_trials / Etiology_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Chin Med J (Engl) Year: 2020 Document type: Article Affiliation country: China