Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study
Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study
Background: Coronary bypass artery grafting (CABG) has a higher procedural risk of stroke than percutaneous coronary intervention (PCI), but may offer better long-term survival. The optimal revascularization strategy for patients with prior cerebrovascular disease (CEVD) remains unclear. Methods and results: The SYNTAXES study assessed the vital status out to 10 year of patients with three-vessel disease and/or left main coronary artery disease enrolled in the SYNTAX trial. The relative efficacy of PCI vs. CABG in terms of 10 year all-cause death was assessed according to prior CEVD. The primary endpoint was 10 year all-cause death. The status of prior CEVD was available in 1791 (99.5%) patients, of whom 253 patients had prior CEVD. Patients with prior CEVD were older and had more comorbidities (medically treated diabetes, insulin-dependent diabetes, metabolic syndrome, peripheral vascular disease, chronic obstructive pulmonary disease, impaired renal function, and congestive heart failure), compared with those without prior CEVD. Prior CEVD was an independent predictor of 10 year all-cause death (adjusted HR: 1.35; 95% CI: 1.04–1.73; p = 0.021). Patients with prior CEVD had a significantly higher risk of 10 year all-cause death (41.1 vs. 24.1%; HR: 1.92; 95% CI: 1.54–2.40; p < 0.001). The risk of 10 year all-cause death was similar between patients receiving PCI or CABG irrespective of the presence of prior CEVD (p
-interaction = 0.624). Conclusion: Prior CEVD was associated with a significantly increased risk of 10 year all-cause death which was similar in patients treated with PCI or CABG. These results do not support preferential referral for PCI rather than CABG in patients with prior CEVD. Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract: [Figure not available: see fulltext.].
CABG, Cerebrovascular disease, Left main coronary artery disease, PCI, Three-vessel disease
1543-1553
Wang, Rutao
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Takahashi, Kuniaki
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Garg, Scot
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Thuijs, Daniel J. F. M.
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Kappetein, Arie Pieter
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Mack, Michael J.
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Morice, Marie-claude
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Mohr, Friedrich-wilhelm
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Curzen, Nick
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Davierwala, Piroze
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Milojevic, Milan
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Van Geuns, Robert Jan
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Head, Stuart J.
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Onuma, Yoshinobu
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Holmes, David R.
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Serruys, Patrick W.
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October 2021
Wang, Rutao
709e794d-93c0-4564-a817-b7c8ad0683fe
Takahashi, Kuniaki
ce404370-6f8b-443b-bd9f-ac499723f473
Garg, Scot
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Thuijs, Daniel J. F. M.
a20f778e-a98b-478d-a848-a41446f4d707
Kappetein, Arie Pieter
32f2d1de-8630-4a3c-a3b8-2db139882bb6
Mack, Michael J.
5fb155bd-62b4-46f4-b1ae-47f594673497
Morice, Marie-claude
8fad799e-b853-419c-a534-c570471dad6f
Mohr, Friedrich-wilhelm
96ed2d2f-5332-47dc-a2cb-67afe8ba319e
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Davierwala, Piroze
ca3ecf52-ca3c-4cd5-89f4-9a0ef4293d59
Milojevic, Milan
2cc58dab-3afb-45d5-b860-01cd32bf39db
Van Geuns, Robert Jan
e136194d-997b-4646-84c6-728fe177eb8a
Head, Stuart J.
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Onuma, Yoshinobu
3bae88ea-1afa-43b2-bbd0-a68d72d78662
Holmes, David R.
66df9a84-7b58-4212-a41f-4154a8361203
Serruys, Patrick W.
98dfd61b-78fb-4f77-9995-7d9959332961
Wang, Rutao, Takahashi, Kuniaki, Garg, Scot, Thuijs, Daniel J. F. M., Kappetein, Arie Pieter, Mack, Michael J., Morice, Marie-claude, Mohr, Friedrich-wilhelm, Curzen, Nick, Davierwala, Piroze, Milojevic, Milan, Van Geuns, Robert Jan, Head, Stuart J., Onuma, Yoshinobu, Holmes, David R. and Serruys, Patrick W.
(2021)
Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study.
Clinical Research in Cardiology, 110 (10), .
(doi:10.1007/s00392-020-01802-x).
Abstract
Background: Coronary bypass artery grafting (CABG) has a higher procedural risk of stroke than percutaneous coronary intervention (PCI), but may offer better long-term survival. The optimal revascularization strategy for patients with prior cerebrovascular disease (CEVD) remains unclear. Methods and results: The SYNTAXES study assessed the vital status out to 10 year of patients with three-vessel disease and/or left main coronary artery disease enrolled in the SYNTAX trial. The relative efficacy of PCI vs. CABG in terms of 10 year all-cause death was assessed according to prior CEVD. The primary endpoint was 10 year all-cause death. The status of prior CEVD was available in 1791 (99.5%) patients, of whom 253 patients had prior CEVD. Patients with prior CEVD were older and had more comorbidities (medically treated diabetes, insulin-dependent diabetes, metabolic syndrome, peripheral vascular disease, chronic obstructive pulmonary disease, impaired renal function, and congestive heart failure), compared with those without prior CEVD. Prior CEVD was an independent predictor of 10 year all-cause death (adjusted HR: 1.35; 95% CI: 1.04–1.73; p = 0.021). Patients with prior CEVD had a significantly higher risk of 10 year all-cause death (41.1 vs. 24.1%; HR: 1.92; 95% CI: 1.54–2.40; p < 0.001). The risk of 10 year all-cause death was similar between patients receiving PCI or CABG irrespective of the presence of prior CEVD (p
-interaction = 0.624). Conclusion: Prior CEVD was associated with a significantly increased risk of 10 year all-cause death which was similar in patients treated with PCI or CABG. These results do not support preferential referral for PCI rather than CABG in patients with prior CEVD. Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract: [Figure not available: see fulltext.].
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e-pub ahead of print date: 30 January 2021
Published date: October 2021
Additional Information:
Funding Information:
The SYNTAX Extended Survival study was supported by the German Foundation of Heart Research (Frankfurt am Main, Germany). The SYNTAX trial, during 0–5 year follow-up, was funded by Boston Scientific Corporation (Marlborough, MA, USA). Both sponsors had no role in the study design, data collection, data analyses and interpretation of the study data, nor were involved in the decision to publish the final manuscript. The principal investigators and authors had complete scientific freedom.
Keywords:
CABG, Cerebrovascular disease, Left main coronary artery disease, PCI, Three-vessel disease
Identifiers
Local EPrints ID: 452990
URI: http://eprints.soton.ac.uk/id/eprint/452990
ISSN: 1861-0684
PURE UUID: 26c3f343-96a7-441b-a224-a379fff9d90e
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Date deposited: 07 Jan 2022 12:10
Last modified: 17 Mar 2024 03:02
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Contributors
Author:
Rutao Wang
Author:
Kuniaki Takahashi
Author:
Scot Garg
Author:
Daniel J. F. M. Thuijs
Author:
Arie Pieter Kappetein
Author:
Michael J. Mack
Author:
Marie-claude Morice
Author:
Friedrich-wilhelm Mohr
Author:
Piroze Davierwala
Author:
Milan Milojevic
Author:
Robert Jan Van Geuns
Author:
Stuart J. Head
Author:
Yoshinobu Onuma
Author:
David R. Holmes
Author:
Patrick W. Serruys
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