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. Graphical abstract: [Figure not available: see fulltext.].
| Original language | English |
|---|---|
| Pages (from-to) | 1302-1311 |
| Number of pages | 10 |
| Journal | Clinical Research in Cardiology |
| Volume | 112 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - Sept 2023 |
Bibliographical note
Funding Information:Open Access funding provided by the IReL Consortium. 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. Science Foundation Ireland (Research Professorship Grant 15/RP/2765) grant to Dr William Wijns supports Drs R. Wang, M. Lunardi and C. Gao.
Funding Information:
The SYNTAX study design and the 5-year results have been published previously [, , ]. The SYNTAX trial completed patient follow-up up to 5 years []. The SYNTAXES study was an investigator-driven initiative that extended follow-up using vital status up to 10 years []. The extended follow-up was funded by German Heart Research Foundation (GHF; Frankfurt am Main, Germany) and performed in accordance with local regulations of each participating center and complied with the Declaration of Helsinki.
Funding Information:
Dr. Burzotta reports speaker’s fees from Abiomed, Abbott, Terumo and Medtronic. Dr. Hara reports a grant for studying overseas from Japanese Circulation Society, a grant-in-Aid for JSPS Fellows, a grant-in-aid from Japan Foundation for Applied Enzymology, and a grant from Fukuda Foundation for Medical Technology. Dr. Davierwala reports speaker’s fees from Medtronic. Dr. Davierwala holds the Angelo & Lorenza De Gasperis Chair in Cardiovascular Surgery Research, an endowed joint Hospital-University Chair among University Health Network (UHN), the University of Toronto (UofT), and UHN Foundation. Dr. Head reports working as a full-time employee of Medtronic outside the scope of this work. Dr. Kappetein reports working as an employee of Medtronic, outside the submitted work. Dr. Serruys reports personal fees from Biosensors, Micel Technologies, Sinomedical Sciences Technology, Philips/Volcano, Xeltis, and HeartFlow, outside the submitted work. Dr. Wijns reports working as Co-founder of Argonauts, an innovation facilitator. All other authors have no disclosures.
Publisher Copyright:
© 2023, The Author(s).