Impact of residual angina on long-term clinical outcomes after percutaneous coronary intervention or coronary artery bypass graft for complex coronary artery disease

Masafumi Ono, Patrick W. Serruys*, the SYNTAX Extended Survival Study Investigators, Hideyuki Kawashima, Mattia Lunardi, Rutao Wang, Hironori Hara, Chao Gao, Scot Garg, Neil O'Leary, Joanna J. Wykrzykowska, Jan J. Piek, David R. Holmes, Marie-Claude Morice, Arie Pieter Kappetein, Thilo Noack, Piroze M. Davierwala, John A. Spertus, David J. Cohen, Yoshinobu Onuma

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Aims The aim of this study was to investigate the impact on 10-year survival of patient-reported anginal status at 1 year following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD) and/or three-vessel CAD (3VD). Methods and results In this post hoc analysis of the randomized SYNTAX Extended Survival study, patients were classified as having residual angina (RA) if their self-reported Seattle Angina Questionnaire angina frequency (SAQ-AF) scale was <= 90 at the 1-year follow-up post-revascularization with PCI or CABG. The primary endpoint of all-cause death at 10 years was compared between the RA and no-RA groups. A sensitivity analysis was performed using a 6-month SAQ-AF. At 1 year, 373 (26.1%) out of 1428 patients reported RA. Whilst RA at 1 year was an independent correlate of repeat revascularization at 5 years [18.3 vs. 11.5%; adjusted hazard ratio (HR): 1.54; 95% confidence interval (CI): 1.10-2.15], it was not associated with all-cause death at 10 years (22.1 vs. 21.6%; adjusted HR: 1.11; 95% CI: 0.83-1.47). These results were consistent when stratified by the modality of revascularization (PCI or CABG) or by anginal frequency. The sensitivity analysis replicating the analyses based on 6-month angina status resulted in similar findings. Conclusion Among patients with LMCAD and/or 3VD, patient-reported RA at 1 year post-revascularization was independently associated with repeat revascularization at 5 years; however, it did not significantly increase 10-year mortality, irrespective of the primary modality of revascularization or severity of RA.
Original languageEnglish
Pages (from-to)490-501
Number of pages12
JournalEuropean heart journal. Quality of care & clinical outcomes
Volume9
Issue number5
Early online date24 Aug 2022
DOIs
Publication statusPublished - 1 Aug 2023

Bibliographical note

Funding Information:
P.W.S. reports personal fees from Biosensors, Micel Technologies, Sinomedical Sciences Technology, Philips/Volcano, Xeltis, and HeartFlow, outside the submitted work. H.H. reports a grant for studying overseas from the Japanese Circulation Society and a grant from the Fukuda Foundation for Medical Technology, outside the submitted work. J.J.P. reports personal fees and non-financial support from Philips/Volcano, outside the submitted work. M.C.M. is the chief executive officer and shareholder of the European Center for Cardiovascular Research, outside the submitted work. A.P.K. report to work as an employee of Medtronic, outside the submitted work. J.A.S. reports grants from Abbott Vascular, outside the submitted work; in addition, J.A.S. has a patent copyright to the Seattle Angina Questionnaire with royalties paid. D.J.C. reports grants from Boston Scientific to Saint Luke's Mid America Heart Institute during the conduct of the study; grants and personal fees from Boston Scientific; grants and personal fees from Abbott; and grants and personal fees from Medtronic, outside the submitted work. All other authors have no conflict of interest to declare.

Funding Information:
The SYNTAX Extended Survival study, during extension of follow-up up to 10 years, 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).

Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.

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