Impact of left ventricular ejection fraction on 10-year mortality in the SYNTAX trial

Shinichiro Masuda; Patrick W. Serruys; the SYNTAX Extended Survival Study Investigators; Kai Ninomiya; Shigetaka Kageyama; Kotoku Nozomi; Chao Gao; Michael J. Mack; David R. Holmes; Marie Claude Morice; Daniel J.F.M. Thuijs; Milan Milojevic; Piroze M. Davierwala; Scot Garg; Yoshinobu Onuma

doi:10.1016/j.carrev.2023.06.031

Impact of left ventricular ejection fraction on 10-year mortality in the SYNTAX trial

Shinichiro Masuda, Patrick W. Serruys^*, the SYNTAX Extended Survival Study Investigators, Kai Ninomiya, Shigetaka Kageyama, Kotoku Nozomi, Chao Gao, Michael J. Mack, David R. Holmes, Marie Claude Morice, Daniel J.F.M. Thuijs, Milan Milojevic, Piroze M. Davierwala, Scot Garg, Yoshinobu Onuma

^*Corresponding author for this work

Cardiothoracic Surgery

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Backgrounds: The impact of reduced left ventricular ejection fraction (LVEF) on very long-term prognosis following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) has been debated. The aim of this study was to investigate the impact of LVEF at baseline on 10-year mortality in the SYNTAX trial. Methods: Patients (n = 1800) were categorized into three sub-groups: reduced (rEF ≤ 40 %), mildly reduced (mrEF 41–49 %), and preserved LVEF (pEF ≥ 50 %). The SYNTAX score 2020 (SS-2020) was applied in patients with LVEF<50 % and ≥ 50 %. Results: Ten-year mortalities were 44.0 %, 31.8 %, and 22.6 % (P < 0.001) in patients with rEF (n = 168), mrEF (n = 179), and pEF (n = 1453). Although no significant differences were observed, the mortality with PCI was higher than with CABG in patients with rEF (52.9 % vs 39.6 %, P = 0.054) and mrEF (36.0 % vs. 28.6 %, P = 0.273), and comparable in pEF (23.9 % vs. 22.2 %, P = 0.275). Calibration and discrimination of the SS-2020 in patients with LVEF<50 % were poor, whilst they were reasonable in those with LVEF≥50 %. The proportion of patients eligible for PCI who had a predicted equipoise in mortality with CABG was estimated to be 57.5 % in patients with LVEF≥50 %. CABG was safer than PCI in 62.2 % of patients with LVEF<50 %. Conclusions: Reduced LVEF was associated with an increased risk of 10-year mortality in patients revascularized either surgically or percutaneously. Compared to PCI, CABG was safe revascularization in patients with LVEF≤40 %. In patients with LVEF≥50 % individualized 10-year all-cause mortality predicted by SS-2020 was helpful in decision-making whilst the predictivity in patients with LVEF<50 % was poor.

Original language	English
Pages (from-to)	7-15
Number of pages	9
Journal	Cardiovascular Revascularization Medicine
Volume	58
Early online date	30 Jun 2023
DOIs	https://doi.org/10.1016/j.carrev.2023.06.031
Publication status	Published - Jan 2024

Bibliographical note

Funding Information:
SYNTAXES was supported by the German Heart Research Foundation (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:
© 2023 The Authors

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Masuda, S., Serruys, P. W., the SYNTAX Extended Survival Study Investigators, Ninomiya, K., Kageyama, S., Nozomi, K., Gao, C., Mack, M. J., Holmes, D. R., Morice, M. C., Thuijs, D. J. F. M., Milojevic, M., Davierwala, P. M., Garg, S., & Onuma, Y. (2024). Impact of left ventricular ejection fraction on 10-year mortality in the SYNTAX trial. Cardiovascular Revascularization Medicine, 58, 7-15. https://doi.org/10.1016/j.carrev.2023.06.031

@article{e042185855a546828ba5b13a50a8aa7e,

title = "Impact of left ventricular ejection fraction on 10-year mortality in the SYNTAX trial",

abstract = "Backgrounds: The impact of reduced left ventricular ejection fraction (LVEF) on very long-term prognosis following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) has been debated. The aim of this study was to investigate the impact of LVEF at baseline on 10-year mortality in the SYNTAX trial. Methods: Patients (n = 1800) were categorized into three sub-groups: reduced (rEF ≤ 40 %), mildly reduced (mrEF 41–49 %), and preserved LVEF (pEF ≥ 50 %). The SYNTAX score 2020 (SS-2020) was applied in patients with LVEF<50 % and ≥ 50 %. Results: Ten-year mortalities were 44.0 %, 31.8 %, and 22.6 % (P < 0.001) in patients with rEF (n = 168), mrEF (n = 179), and pEF (n = 1453). Although no significant differences were observed, the mortality with PCI was higher than with CABG in patients with rEF (52.9 % vs 39.6 %, P = 0.054) and mrEF (36.0 % vs. 28.6 %, P = 0.273), and comparable in pEF (23.9 % vs. 22.2 %, P = 0.275). Calibration and discrimination of the SS-2020 in patients with LVEF<50 % were poor, whilst they were reasonable in those with LVEF≥50 %. The proportion of patients eligible for PCI who had a predicted equipoise in mortality with CABG was estimated to be 57.5 % in patients with LVEF≥50 %. CABG was safer than PCI in 62.2 % of patients with LVEF<50 %. Conclusions: Reduced LVEF was associated with an increased risk of 10-year mortality in patients revascularized either surgically or percutaneously. Compared to PCI, CABG was safe revascularization in patients with LVEF≤40 %. In patients with LVEF≥50 % individualized 10-year all-cause mortality predicted by SS-2020 was helpful in decision-making whilst the predictivity in patients with LVEF<50 % was poor.",

author = "Shinichiro Masuda and Serruys, {Patrick W.} and {the SYNTAX Extended Survival Study Investigators} and Kai Ninomiya and Shigetaka Kageyama and Kotoku Nozomi and Chao Gao and Mack, {Michael J.} and Holmes, {David R.} and Morice, {Marie Claude} and Thuijs, {Daniel J.F.M.} and Milan Milojevic and Davierwala, {Piroze M.} and Scot Garg and Yoshinobu Onuma",

note = "Funding Information: SYNTAXES was supported by the German Heart Research Foundation (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: {\textcopyright} 2023 The Authors",

year = "2024",

month = jan,

doi = "10.1016/j.carrev.2023.06.031",

language = "English",

volume = "58",

pages = "7--15",

journal = "Cardiovascular Revascularization Medicine",

issn = "1553-8389",

publisher = "Elsevier Inc.",

}

Masuda, S, Serruys, PW, the SYNTAX Extended Survival Study Investigators, Ninomiya, K, Kageyama, S, Nozomi, K, Gao, C, Mack, MJ, Holmes, DR, Morice, MC, Thuijs, DJFM, Milojevic, M, Davierwala, PM, Garg, S & Onuma, Y 2024, 'Impact of left ventricular ejection fraction on 10-year mortality in the SYNTAX trial', Cardiovascular Revascularization Medicine, vol. 58, pp. 7-15. https://doi.org/10.1016/j.carrev.2023.06.031

TY - JOUR

T1 - Impact of left ventricular ejection fraction on 10-year mortality in the SYNTAX trial

AU - Masuda, Shinichiro

AU - Serruys, Patrick W.

AU - the SYNTAX Extended Survival Study Investigators

AU - Ninomiya, Kai

AU - Kageyama, Shigetaka

AU - Nozomi, Kotoku

AU - Gao, Chao

AU - Mack, Michael J.

AU - Holmes, David R.

AU - Morice, Marie Claude

AU - Thuijs, Daniel J.F.M.

AU - Milojevic, Milan

AU - Davierwala, Piroze M.

AU - Garg, Scot

AU - Onuma, Yoshinobu

N1 - Funding Information: SYNTAXES was supported by the German Heart Research Foundation (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: © 2023 The Authors

PY - 2024/1

Y1 - 2024/1

N2 - Backgrounds: The impact of reduced left ventricular ejection fraction (LVEF) on very long-term prognosis following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) has been debated. The aim of this study was to investigate the impact of LVEF at baseline on 10-year mortality in the SYNTAX trial. Methods: Patients (n = 1800) were categorized into three sub-groups: reduced (rEF ≤ 40 %), mildly reduced (mrEF 41–49 %), and preserved LVEF (pEF ≥ 50 %). The SYNTAX score 2020 (SS-2020) was applied in patients with LVEF<50 % and ≥ 50 %. Results: Ten-year mortalities were 44.0 %, 31.8 %, and 22.6 % (P < 0.001) in patients with rEF (n = 168), mrEF (n = 179), and pEF (n = 1453). Although no significant differences were observed, the mortality with PCI was higher than with CABG in patients with rEF (52.9 % vs 39.6 %, P = 0.054) and mrEF (36.0 % vs. 28.6 %, P = 0.273), and comparable in pEF (23.9 % vs. 22.2 %, P = 0.275). Calibration and discrimination of the SS-2020 in patients with LVEF<50 % were poor, whilst they were reasonable in those with LVEF≥50 %. The proportion of patients eligible for PCI who had a predicted equipoise in mortality with CABG was estimated to be 57.5 % in patients with LVEF≥50 %. CABG was safer than PCI in 62.2 % of patients with LVEF<50 %. Conclusions: Reduced LVEF was associated with an increased risk of 10-year mortality in patients revascularized either surgically or percutaneously. Compared to PCI, CABG was safe revascularization in patients with LVEF≤40 %. In patients with LVEF≥50 % individualized 10-year all-cause mortality predicted by SS-2020 was helpful in decision-making whilst the predictivity in patients with LVEF<50 % was poor.

AB - Backgrounds: The impact of reduced left ventricular ejection fraction (LVEF) on very long-term prognosis following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) has been debated. The aim of this study was to investigate the impact of LVEF at baseline on 10-year mortality in the SYNTAX trial. Methods: Patients (n = 1800) were categorized into three sub-groups: reduced (rEF ≤ 40 %), mildly reduced (mrEF 41–49 %), and preserved LVEF (pEF ≥ 50 %). The SYNTAX score 2020 (SS-2020) was applied in patients with LVEF<50 % and ≥ 50 %. Results: Ten-year mortalities were 44.0 %, 31.8 %, and 22.6 % (P < 0.001) in patients with rEF (n = 168), mrEF (n = 179), and pEF (n = 1453). Although no significant differences were observed, the mortality with PCI was higher than with CABG in patients with rEF (52.9 % vs 39.6 %, P = 0.054) and mrEF (36.0 % vs. 28.6 %, P = 0.273), and comparable in pEF (23.9 % vs. 22.2 %, P = 0.275). Calibration and discrimination of the SS-2020 in patients with LVEF<50 % were poor, whilst they were reasonable in those with LVEF≥50 %. The proportion of patients eligible for PCI who had a predicted equipoise in mortality with CABG was estimated to be 57.5 % in patients with LVEF≥50 %. CABG was safer than PCI in 62.2 % of patients with LVEF<50 %. Conclusions: Reduced LVEF was associated with an increased risk of 10-year mortality in patients revascularized either surgically or percutaneously. Compared to PCI, CABG was safe revascularization in patients with LVEF≤40 %. In patients with LVEF≥50 % individualized 10-year all-cause mortality predicted by SS-2020 was helpful in decision-making whilst the predictivity in patients with LVEF<50 % was poor.

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DO - 10.1016/j.carrev.2023.06.031

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SN - 1553-8389

VL - 58

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JO - Cardiovascular Revascularization Medicine

JF - Cardiovascular Revascularization Medicine

ER -

Impact of left ventricular ejection fraction on 10-year mortality in the SYNTAX trial

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