Mis-estimation of coronary lesions and rectification by SYNTAX score feedback for coronary revascularization appropriateness.
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, nâ=â1525) or the intervention group (03/2017-09/2017, nâ=â1720). 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; Pâ=â0.007). Both inappropriate percutaneous coronary intervention (adjusted OR 0.82; 95% CI 0.74-0.92; Pâ<â0.001) and percutaneous coronary intervention utilization (adjusted OR 0.88; 95% CI 0.79-0.98; Pâ=â0.016) 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.
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