October Cardiologists identify model to weigh risks & benefits of surgery Vs stenting for treatments of coronary artery diseases

NUI Galway interventional cardiologists identify new model to weigh up risk and benefits of surgery versus stenting for treatments of complex coronary artery disease   

Findings of research team led by Professor Patrick W Serruys published in The Lancet 

Researchers at NUI Galway’s CORRIB Research Centre for Advanced Imaging and Core Laboratory have developed a new model for assessing treatments to improve outcomes for patients with complex coronary artery disease.

The group have expanded clinical assessment modelling which may improve the ability of medical professionals to inform patients and their families about the potential risks and benefits of alternative treatments for a disease that causes the death of 17.9 million people worldwide each year.

The new assessment model will also support more open and shared decision-making process between doctors, patients and their families.

The research is led by world renowned expert on interventional cardiology, Professor Patrick W Serruys, who was the first person to treat patients with a drug-eluting stent in 1999 and further revolutionized the field of interventional cardiology when introducing the use of fully biodegradable drug-eluting scaffolds.

This study, ‘Individualized Decision Making between Percutaneous and Surgical Revascularization in Patients withComplex Coronary Artery Disease: Redevelopment and Validation of the SYNTAX Score 2020’, has been published in world leading medical scientific journal The Lancet (today Thursday, 8 October 2020).

The research aims to enhance understanding of the optimal treatment strategy for individual patients with complex coronary artery disease. It also aims to negate the bias of individual doctors towards certain treatments (i.e. bypass or stenting), in favour of a more personalized, rounded and better considered method of treatment based on a patient's medical history, condition and other factors.  

The SYNTAX Score 2020 analyses a number of factors including age, kidney function, ability of the heart to pump blood around the body, compounding heart disease and diabetes and smoking status. This range is used in order to individually predict the patient's 10-year mortality and 5-year major adverse cardiac events and help the Heart Team in the hospital identify whether the patient would benefit more from bypass surgery or treatment with stents.

The research team used data from a landmark SYNTAXES clinical trial to develop a predictive model that explicitly considers baseline outcome risk, so that they can distinguish between patients who benefit from bypass surgery and those who may benefit from stent application. 

The SYNTAXES study demonstrated no significant difference in 10-year all-cause death between patients randomized to bypass vs stenting.

In contrast, the predictive model from the NUI Galway analysis provides a more nuanced interpretation of the results by identifying patients who derive substantial survival benefit from bypass surgery versus stenting, and those for whom there is little expected difference between the strategies. 

Professor Serruys said: “We consider that one treatment (bypass) versus another (stent) is not globally superior, inferior or equal, but a specific treatment is superior, inferior or equal for a specific patient.

“For this individualized decision-making, the SYNTAX Score 2020 model generates a prediction of treatment benefit for individual patients based on their angiographic and clinical variables.” 

Professor Serruys expands: “The ratios of different treatment choices vary across Europe and even across regions in European countries, where doctors may prefer a particular treatment based on their experience, specialty or background. These do not always represent guideline recommendations, potentially resulting in inaccurate risk assessment and the choice of inappropriate treatments with suboptimal outcomes.

“If the Heart Team in a hospital uses our model for a patient, it should enable a more individualized and patient-centered care in patients with complex coronary artery disease.” 

Prof Serruys and the extended study team, including Professor Yoshinobu Onuma, Director of Coronary Imaging and Atherosclerosis Research at CORRIB Core Lab at NUI Galway, have recommended further studies based on adequately powered randomized trials of bypass versus stenting, with 5-10 year follow-up using contemporary revascularization techniques, devices and adjunctive medical therapy to prospectively validate the SYNTAX Score 2020 model.

Prof Onuma added: “Our new model provides expected probabilities of 5 and 10 year outcomes. This may improve the ability of the Heart Team to inform patients and their families about the potential risks and rewards of alternative treatments for complex coronary artery disease and support a more transparent shared decision-making process.” 

The full text of the article is being made available here http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32114-0/fulltext

-Ends-