دورية أكاديمية
Redevelopment and validation of the SYNTAX score II to individualise decision making between percutaneous and surgical revascularisation in patients with complex coronary artery disease: secondary analysis of the multicentre randomised controlled SYNTAXES trial with external cohort validation
| العنوان: | Redevelopment and validation of the SYNTAX score II to individualise decision making between percutaneous and surgical revascularisation in patients with complex coronary artery disease: secondary analysis of the multicentre randomised controlled SYNTAXES trial with external cohort validation |
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| المؤلفون: | Takahashi, K., Serruys, P.W., Fuster, V., Farkouh, M.E., Spertus, J.A., Cohen, D.J., Park, S.J., Park, D.W., Ahn, J.M., Kappetein, A.P., Head, S.J., Thuijs, D.J.F.M., Onuma, Y., Kent, D.M., Steyerberg, E.W., Klaveren, D. van, SYNTAXES Trial Investigator, FREEDOM Trial Investigator, BEST Trial Investigator, PRECOMBAT Trial Investigator |
| المصدر: | Lancet |
| سنة النشر: | 2020 |
| المجموعة: | Leiden Repository (Leiden University) |
| الوصف: | Background Randomised controlled trials are considered the gold standard for testing the efficacy of novel therapeutic interventions, and typically report the average treatment effect as a summary result. As the result of treatment can vary between patients, basing treatment decisions for individual patients on the overall average treatment effect could be suboptimal. We aimed to develop an individualised decision making tool to select an optimal revascularisation strategy in patients with complex coronary artery disease.Methods The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries between March, 2005, and April, 2007. Patients with de-novo three-vessel and left main coronary artery disease were randomly assigned (1:1) to either the percutaneous coronary intervention (PCI) group or coronary artery bypass grafting (CABG) group. The SYNTAXES study ascertained 10-year all-cause deaths. We used Cox regression to develop a clinical prognostic index for predicting death over a 10-year period, which was combined, in a second stage, with assigned treatment (PCI or CABG) and two prespecified effect-modifiers, which were selected on the basis of previous evidence: disease type (three-vessel disease or left main coronary artery disease) and anatomical SYNTAX score. We used similar techniques to develop a model to predict the 5-year risk of major adverse cardiovascular events (defined as a composite of all-cause death, non-fatal stroke, or non-fatal myocardial infarction) in patients receiving PCI or CABG. We then assessed the ability of these models to predict the risk of death or a major adverse cardiovascular event, and their differences (ie, the estimated benefit of CABG versus PCI by calculating the absolute risk difference between the two strategies) by cross-validation with the SYNTAX trial (n=1800 participants) and external validation in the pooled population ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| العلاقة: | lumc-id: 115311410; https://hdl.handle.net/1887/3185123Test |
| DOI: | 10.1016/S0140-6736(20)32114-0 |
| الإتاحة: | https://doi.org/10.1016/S0140-6736Test(20)32114-0 https://hdl.handle.net/1887/3185123Test |
| رقم الانضمام: | edsbas.BDF0AE30 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1016/S0140-6736(20)32114-0 |
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