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SYNTAX-justified trend toward restricting coronary artery bypass grafting to more serious cases

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Abstract

Objective

Since drug-eluting stents (DESs) appeared in Japan, coronary artery bypass grafting (CABG) has been indicated for more severe lesions. To understand the implications of this trend, we compared SYNTAX scores in two groups of patients treated with CABG before and after DESs approval.

Methods

Consecutive CABG patients during January 2001–July 2003 (pre-DES era patients, n = 160) and January 2008–July 2010 (DES era patients, n = 103) were included. The SYNTAX scores of both groups were compared and a cardiologist retrospectively re-evaluated coronary angiograms to determine whether CABG or percutaneous coronary intervention (PCI) would be recommended under current standards.

Results

SYNTAX scores were significantly higher in DES era group compared with pre-DES era group (33.3 ± 10.6 vs. 28.1 ± 10.6, p < 0.01). Percutaneous coronary intervention would be the preferred treatment option in 66 (41 %) of pre-DES patients, whose SYNTAX scores were significantly lower than those of patients who were considered good candidates for CABG (21.9 ± 9.3 vs. 32.5 ± 9.1, p < 0.01).

Conclusions

Although CABG is now being performed in intermediate-to-highly complex cases, DES era outcomes, including operative mortality and early graft failure, have not worsened in comparison to the pre-DES era.

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Conflict of interest

Author who has any potential conflicts of interest: Honoraria: Junya Ako (Abbott Vascular). The other authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan

    Mamoru Arakawa, Atsushi Yamaguchi, Homare Okamura & Hideo Adachi

  2. Department of Cardiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    Kenichi Sakakura, Junya Ako & Shin-ichi Momomura

Authors
  1. Mamoru Arakawa
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  2. Atsushi Yamaguchi
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  3. Kenichi Sakakura
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  4. Homare Okamura
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  5. Junya Ako
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  6. Shin-ichi Momomura
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  7. Hideo Adachi
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Correspondence to Mamoru Arakawa.

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Arakawa, M., Yamaguchi, A., Sakakura, K. et al. SYNTAX-justified trend toward restricting coronary artery bypass grafting to more serious cases. Gen Thorac Cardiovasc Surg 62, 364–369 (2014). https://doi.org/10.1007/s11748-013-0360-z

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  • DOI: https://doi.org/10.1007/s11748-013-0360-z

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