Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization
Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization
Background: the SYNTAX trial demonstrated negative impact of repeat revascularization (RR) on 5-year outcomes following PCI/CABG in patients with three-vessel(3VD) and/or left main coronary artery disease(LMCAD). We aimed to investigate the impact of RR within 5 years, on 10-year mortality in patients with 3VD and/or LMCAD after PCI/CABG.
Methods: the SYNTAXES study evaluated the vital status out to 10 years of patients with 3VD and/or LMCAD. Patients were stratified by RR within 5 years and randomized treatment. The association between RR within 5 years and 10-year mortality was assessed.
Results: a total of 330 out of 1800 patients (18.3%) underwent RR within 5 years. RR occurred more frequently after initial PCI than after initial CABG (25.9% vs. 13.7%, p < 0.001). Overall, 10-year mortality was comparable between patients undergoing RR and those not (28.2% vs. 26.1%, adjusted HR: 1.17, 95%CI 0.93–1.48, p = 0.187). In the PCI arm, RR was associated with a trend toward higher 10-year mortality (adjusted HR: 1.29, 95%CI 0.97–1.72, p = 0.075), while in the CABG arm, the trend was opposite (adjusted HR: 0.74, 95%CI 0.46–1.20, p = 0.219). Among patients requiring RR, those who underwent PCI as initial revascularization had a higher risk of 10-year mortality compared to initial CABG (33.5% vs. 17.6%, adjusted HR: 2.09, 95%CI 1.21–3.61, p = 0.008).
Conclusion: in the SYNTAXES study, RR within 5 years had no impact on 10-year all-cause death in the population overall. Among patients requiring any repeat procedures, 10-year mortality was higher after initial treatment with PCI than after CABG. These exploratory findings should be investigated with larger populations in future studies.
Trial registration: URL: https://www.clinicaltrials.gov; SYNTAXES Unique identifier: NCT03417050. URL: https://www.clinicaltrials.gov; SYNTAX Unique identifier: NCT00114972.
1302-1311
Wang, Rutao
a2b885ef-8d97-4998-ad93-7132a4ca4139
Lunardi, Mattia
5ec6c1d3-9327-4ff8-b473-5e5d0724718a
Hara, Hironori
7003f375-9944-4d74-98af-8bc855d4e703
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Wang, Rutao
a2b885ef-8d97-4998-ad93-7132a4ca4139
Lunardi, Mattia
5ec6c1d3-9327-4ff8-b473-5e5d0724718a
Hara, Hironori
7003f375-9944-4d74-98af-8bc855d4e703
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Wang, Rutao, Lunardi, Mattia and Hara, Hironori
,
et al.
(2023)
Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization.
Clinical Research in Cardiology, 112 (9), .
(doi:10.1007/s00392-023-02211-6).
Abstract
Background: the SYNTAX trial demonstrated negative impact of repeat revascularization (RR) on 5-year outcomes following PCI/CABG in patients with three-vessel(3VD) and/or left main coronary artery disease(LMCAD). We aimed to investigate the impact of RR within 5 years, on 10-year mortality in patients with 3VD and/or LMCAD after PCI/CABG.
Methods: the SYNTAXES study evaluated the vital status out to 10 years of patients with 3VD and/or LMCAD. Patients were stratified by RR within 5 years and randomized treatment. The association between RR within 5 years and 10-year mortality was assessed.
Results: a total of 330 out of 1800 patients (18.3%) underwent RR within 5 years. RR occurred more frequently after initial PCI than after initial CABG (25.9% vs. 13.7%, p < 0.001). Overall, 10-year mortality was comparable between patients undergoing RR and those not (28.2% vs. 26.1%, adjusted HR: 1.17, 95%CI 0.93–1.48, p = 0.187). In the PCI arm, RR was associated with a trend toward higher 10-year mortality (adjusted HR: 1.29, 95%CI 0.97–1.72, p = 0.075), while in the CABG arm, the trend was opposite (adjusted HR: 0.74, 95%CI 0.46–1.20, p = 0.219). Among patients requiring RR, those who underwent PCI as initial revascularization had a higher risk of 10-year mortality compared to initial CABG (33.5% vs. 17.6%, adjusted HR: 2.09, 95%CI 1.21–3.61, p = 0.008).
Conclusion: in the SYNTAXES study, RR within 5 years had no impact on 10-year all-cause death in the population overall. Among patients requiring any repeat procedures, 10-year mortality was higher after initial treatment with PCI than after CABG. These exploratory findings should be investigated with larger populations in future studies.
Trial registration: URL: https://www.clinicaltrials.gov; SYNTAXES Unique identifier: NCT03417050. URL: https://www.clinicaltrials.gov; SYNTAX Unique identifier: NCT00114972.
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s00392-023-02211-6
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Accepted/In Press date: 17 April 2023
e-pub ahead of print date: 8 May 2023
Additional Information:
Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization. Wang R, Lunardi M, Hara H, Gao C, Ono M, Davierwala PM, Holmes DR, Mohr FW, Curzen N, Burzotta F, van Geuns RJ, Kappetein AP, Head SJ, Thuijs DJFM, Tao L, Garg S, Onuma Y, Wijns W, Serruys PW. Clin Res Cardiol. 2023 Sep;112(9):1302-1311. doi: 10.1007/s00392-023-02211-6. Epub 2023 May 8.PMID: 37150783 Free PMC article. Clinical Trial.
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Local EPrints ID: 491933
URI: http://eprints.soton.ac.uk/id/eprint/491933
ISSN: 1861-0684
PURE UUID: 96fb4eff-f782-4e8d-93aa-21703336d8a0
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Date deposited: 08 Jul 2024 17:24
Last modified: 12 Jul 2024 01:43
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Author:
Rutao Wang
Author:
Mattia Lunardi
Author:
Hironori Hara
Corporate Author: et al.
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