Geographic disparity in 10-year mortality after coronary artery revascularization in the SYNTAXES trial
Geographic disparity in 10-year mortality after coronary artery revascularization in the SYNTAXES trial
Aims: to investigate geographic disparity in long-term mortality following revascularization in patients with complex coronary artery disease (CAD).
Methods and results: the SYNTAXES trial randomized 1800 patients with three-vessel and/or left main CAD to percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and assessed their survival at 10 years. Patients were stratified according to the region of recruitment: North America (N-A, n = 245), Eastern Europe (E-E, n = 189), Northern Europe (N-E, n = 425), Southern Europe (S-E, n = 263), and Western Europe (W-E, n = 678), which also served as the reference group. Compared to W-E, patients were younger in E-E (62 vs 65 years, p < 0.001), and less frequently male in N-A (65.3% vs 79.6%, p < 0.001). Diabetes (16.0% vs 25.4%, p < 0.001) and peripheral vascular disease (6.8% vs 10.9%, p = 0.025) were less frequent in N-E than W-E. Ejection fraction was highest in W-E (62% vs 56%, p < 0.001). Compared to W-E, the mean anatomic SYNTAX score was higher in S-E (29 vs 31, p = 0.008) and lower in N-A (26, p < 0.001). Crude ten-year mortality was similar in N-A (31.6%), and W-E (30.7%), and significantly lower in E-E (22.5%, p = 0.041), N-E (21.9%, p = 0.003) and S-E (22.0%, p = 0.014). Compared to W-E, adjusted mortality in N-E (HR 0.85, p = 0.019) and S-E (HR 0.72, p = 0.043) remain significantly lower after adjustment for pre- and peri-procedural factors, but no significant interaction (P interaction = 0.728) between region and modality of revascularization was seen.
Conclusion: in the era of globalization, knowledge, and understanding of geographic disparity are of paramount importance for the correct interpretation of global studies.
Complex coronary artery disease, Geographic disparity, Revascularization, Ten-year mortality
28-38
Kageyama, Shigetaka
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Serruys, Patrick W.
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Garg, Scot
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Ninomiya, Kai
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Masuda, Shinichiro
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Kotoku, Nozomi
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Colombo, Antonio
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Mack, Michael J.
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Banning, Adrian P.
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Morice, Marie-claude
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Witkowski, Adam
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Curzen, Nick
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Burzotta, Francesco
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James, Stefan
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Van Geuns, Robert-jan
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Davierwala, Piroze M.
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Holmes, David R.
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Wood, David A.
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Mcevoy, John William
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Onuma, Yoshinobu
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1 December 2022
Kageyama, Shigetaka
e2a1ec5a-ecf4-44e6-98cd-a77f098be2a0
Serruys, Patrick W.
98dfd61b-78fb-4f77-9995-7d9959332961
Garg, Scot
f504ab90-e0d5-4567-9c49-0c6cf2137c74
Ninomiya, Kai
f23e5be9-f68f-4bca-9a13-35d3b1f892a4
Masuda, Shinichiro
35af3b88-dce1-473e-bbd2-8575114b7938
Kotoku, Nozomi
234444a9-ab1b-425a-af18-1c87d9cb791e
Colombo, Antonio
4d0610e9-c0d7-42d8-bb47-421502b0bbe8
Mack, Michael J.
5fb155bd-62b4-46f4-b1ae-47f594673497
Banning, Adrian P.
63c9376f-08b6-4578-b036-4d6233545270
Morice, Marie-claude
8fad799e-b853-419c-a534-c570471dad6f
Witkowski, Adam
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Curzen, Nick
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Burzotta, Francesco
f08c659b-dc57-46d8-a00d-04ac0c8b25a6
James, Stefan
4bd89951-d838-4769-8154-76ca9071ea6e
Van Geuns, Robert-jan
e136194d-997b-4646-84c6-728fe177eb8a
Davierwala, Piroze M.
c748d037-998c-4cff-a808-3887c2ecc49d
Holmes, David R.
c9404d79-4290-410e-a764-0c70ecbb4578
Wood, David A.
fef14be7-aad7-4552-8382-3939a018be1b
Mcevoy, John William
1c2f478a-940b-49ab-a360-3069eaf6b58d
Onuma, Yoshinobu
3bae88ea-1afa-43b2-bbd0-a68d72d78662
Kageyama, Shigetaka, Serruys, Patrick W., Garg, Scot, Ninomiya, Kai, Masuda, Shinichiro, Kotoku, Nozomi, Colombo, Antonio, Mack, Michael J., Banning, Adrian P., Morice, Marie-claude, Witkowski, Adam, Curzen, Nick, Burzotta, Francesco, James, Stefan, Van Geuns, Robert-jan, Davierwala, Piroze M., Holmes, David R., Wood, David A., Mcevoy, John William and Onuma, Yoshinobu
(2022)
Geographic disparity in 10-year mortality after coronary artery revascularization in the SYNTAXES trial.
International Journal of Cardiology, 368, .
(doi:10.1016/j.ijcard.2022.08.013).
Abstract
Aims: to investigate geographic disparity in long-term mortality following revascularization in patients with complex coronary artery disease (CAD).
Methods and results: the SYNTAXES trial randomized 1800 patients with three-vessel and/or left main CAD to percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and assessed their survival at 10 years. Patients were stratified according to the region of recruitment: North America (N-A, n = 245), Eastern Europe (E-E, n = 189), Northern Europe (N-E, n = 425), Southern Europe (S-E, n = 263), and Western Europe (W-E, n = 678), which also served as the reference group. Compared to W-E, patients were younger in E-E (62 vs 65 years, p < 0.001), and less frequently male in N-A (65.3% vs 79.6%, p < 0.001). Diabetes (16.0% vs 25.4%, p < 0.001) and peripheral vascular disease (6.8% vs 10.9%, p = 0.025) were less frequent in N-E than W-E. Ejection fraction was highest in W-E (62% vs 56%, p < 0.001). Compared to W-E, the mean anatomic SYNTAX score was higher in S-E (29 vs 31, p = 0.008) and lower in N-A (26, p < 0.001). Crude ten-year mortality was similar in N-A (31.6%), and W-E (30.7%), and significantly lower in E-E (22.5%, p = 0.041), N-E (21.9%, p = 0.003) and S-E (22.0%, p = 0.014). Compared to W-E, adjusted mortality in N-E (HR 0.85, p = 0.019) and S-E (HR 0.72, p = 0.043) remain significantly lower after adjustment for pre- and peri-procedural factors, but no significant interaction (P interaction = 0.728) between region and modality of revascularization was seen.
Conclusion: in the era of globalization, knowledge, and understanding of geographic disparity are of paramount importance for the correct interpretation of global studies.
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Accepted/In Press date: 4 August 2022
e-pub ahead of print date: 6 August 2022
Published date: 1 December 2022
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 years 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.
Publisher Copyright:
© 2022 Elsevier B.V.
Keywords:
Complex coronary artery disease, Geographic disparity, Revascularization, Ten-year mortality
Identifiers
Local EPrints ID: 470102
URI: http://eprints.soton.ac.uk/id/eprint/470102
ISSN: 0167-5273
PURE UUID: e00f7730-edd8-4275-b49b-e9c6925136f9
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Date deposited: 03 Oct 2022 16:50
Last modified: 17 Mar 2024 07:28
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Contributors
Author:
Shigetaka Kageyama
Author:
Patrick W. Serruys
Author:
Scot Garg
Author:
Kai Ninomiya
Author:
Shinichiro Masuda
Author:
Nozomi Kotoku
Author:
Antonio Colombo
Author:
Michael J. Mack
Author:
Adrian P. Banning
Author:
Marie-claude Morice
Author:
Adam Witkowski
Author:
Francesco Burzotta
Author:
Stefan James
Author:
Robert-jan Van Geuns
Author:
Piroze M. Davierwala
Author:
David R. Holmes
Author:
David A. Wood
Author:
John William Mcevoy
Author:
Yoshinobu Onuma
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