Predicted and Observed Mortality at 10 Years in Patients With Bifurcation Lesions in the SYNTAX Trial

Kai Ninomiya, Patrick W. Serruys*, SYNTAX Extended Survival Investigators, Scot Garg, Chao Gao, Shinichiro Masuda, Mattia Lunardi, Jens F. Lassen, Adrian P. Banning, Antonio Colombo, Francesco Burzotta, Marie Claude Morice, Michael J. Mack, David R. Holmes, Piroze M. Davierwala, Daniel J.F.M. Thuijs, David van Klaveren, Yoshinobu Onuma

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: Percutaneous coronary intervention (PCI) of bifurcation lesions is associated with higher rates of adverse events, and currently it is unclear whether PCI or coronary artery bypass grafting (CABG) is the safer treatment for these patients at very long-term follow-up. Objectives: The aim of this study was to investigate the impact of bifurcation lesions on individual predicted and observed all-cause 10-year mortality in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial. Methods: In the SYNTAXES (SYNTAX Extended Survival) study, 10-year observed and individual predicted mortality derived from the SYNTAX score 2020 (SS-2020) was compared between patients with ≥1 bifurcation (n = 1,300) and those with no bifurcations (n = 487). Results: Among patients treated with PCI, patients with >1 bifurcation lesion compared with those without bifurcation lesions had a significantly higher risk for all-cause death (19.8% vs 30.1%; HR: 1.55; 95% CI: 1.12-2.14; P = 0.007), whereas following CABG, mortality was similar in patients with and those without bifurcation lesions (23.3% vs 23.0%; HR: 0.81; 95% CI: 0.59-1.12; P = 0.207; Pinteraction = 0.006). In PCI patients, a 2-stent vs a 1-stent technique was associated with higher mortality (33.3% vs 25.9%; HR: 1.51; 95% CI: 1.06-2.14; P = 0.021). According to the SS-2020, among those with ≥1 bifurcation, there was equipoise for all-cause mortality between PCI and CABG in 2 quartiles of the population, whereas CABG was superior to PCI in the 2 remaining quartiles. Conclusions: Bifurcation lesions require special attention from the heart team, considering the higher 10-year all-cause mortality associated with PCI. Careful evaluation of bifurcation lesion complexity and calculation of individualized 10-year prognosis using the SS-2020 may therefore be helpful in decision making. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES], NCT03417050; Taxus Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX], NCT00114972)

Original languageEnglish
Pages (from-to)1231-1242
Number of pages12
JournalJACC: Cardiovascular Interventions
Issue number12
Early online date20 Jun 2022
Publication statusPublished - 27 Jun 2022

Bibliographical note

Funding Information:
SYNTAXES was supported by the German Foundation of Heart Research. The SYNTAX trial, during 0- to 5-year follow-up, was funded by Boston Scientific. Both sponsors had no role in study design, data collection, data analyses, and interpretation of the study data and were not involved in the decision to publish the final manuscript. The principal investigators and authors had complete scientific freedom. Dr Ninomiya has received a grant from Abbott Medical Japan, outside the submitted work. Dr Serruys has received institutional grants from Sinomedical Sciences Technology, Sahajanand Medical Technological, Philips/Volcano, Xeltis, and HeartFlow, outside the submitted work. Dr Masuda has received a grant from Terumo, outside the submitted work. Dr Morice is the CEO and a shareholder of CERC, a contract research organization based in Paris, which had no role in this trial. Dr Burzotta has received speaker fees from Abbott, Abiomed, Medtronic, and Terumo. Dr Banning has received an institutional educational grant for a fellowship from Boston Scientific; and has received speaker fees from Boston Scientific, Medtronic, and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2022 American College of Cardiology Foundation


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