Single or multiple arterial bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel or left main coronary artery disease

Piroze M. Davierwala; Chao Gao; Daniel J.F.M. Thuijs; Rutao Wang; Hironori Hara; Masafumi Ono; Thilo Noack; Scot Garg; Neil O'Leary; Milan Milojevic; Arie Pieter Kappetein; Marie Claude Morice; Michael J. Mack; Robert Jan Van Geuns; David R. Holmes; Mario Gaudino; David P. Taggart; Yoshinobu Onuma; Friedrich Wilhelm Mohr; Patrick W. Serruys

doi:10.1093/eurheartj/ehab537

Single or multiple arterial bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel or left main coronary artery disease

Piroze M. Davierwala, Chao Gao, Daniel J.F.M. Thuijs, Rutao Wang, Hironori Hara, Masafumi Ono, Thilo Noack, Scot Garg, Neil O'Leary, Milan Milojevic, Arie Pieter Kappetein, Marie Claude Morice, Michael J. Mack, Robert Jan Van Geuns, David R. Holmes, Mario Gaudino, David P. Taggart, Yoshinobu Onuma, Friedrich Wilhelm Mohr, Patrick W. Serruys^*

^*Corresponding author for this work

Cardiothoracic Surgery

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

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Abstract

Aim: The aim of this study was to compare long-term all-cause mortality between patients receiving percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using multiple (MAG) or single arterial grafting (SAG). Methods and results: The current study is a post hoc analysis of the SYNTAX Extended Survival Study, which compared PCI with CABG in patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD) and evaluated survival with ≥10 years of follow-up. The primary endpoint was all-cause mortality at maximum follow-up (median 11.9 years) assessed in the as-treated population. Of the 1743 patients, 901 (51.7%) underwent PCI, 532 (30.5%) received SAG, and 310 (17.8%) had MAG. At maximum follow-up, all-cause death occurred in 305 (33.9%), 175 (32.9%), and 70 (22.6%) patients in the PCI, SAG, and MAG groups, respectively (P < 0.001). Multiple arterial grafting [adjusted hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.49-0.89], but not SAG (adjusted HR 0.83, 95% CI 0.67-1.03), was associated with significantly lower all-cause mortality compared with PCI. In patients with 3VD, both MAG (adjusted HR 0.55, 95% CI 0.37-0.81) and SAG (adjusted HR 0.68, 95% CI 0.50-0.91) were associated with significantly lower mortality than PCI, whereas in LMCAD patients, no significant differences between PCI and MAG (adjusted HR 0.90, 95% CI 0.56-1.46) or SAG (adjusted HR 1.11, 95% CI 0.81-1.53) were observed. In patients with revascularization of all three major myocardial territories, a positive correlation was observed between the number of myocardial territories receiving arterial grafts and survival (Ptrend = 0.003). Conclusion: Our findings suggest that MAG might be the more desirable configuration for CABG to achieve lower long-term all-cause mortality than PCI in patients with 3VD and/or LMCAD. Trial registration: Registered on clinicaltrial.gov. SYNTAXES: NCT03417050 (https://clinicaltrials.gov/ct2/show/NCT03417050); SYNTAX: NCT00114972 (https://www.clinicaltrials.gov/ct2/show/NCT00114972).

Original language	English
Pages (from-to)	1334-1344
Number of pages	11
Journal	European Heart Journal
Volume	43
Issue number	13
DOIs	https://doi.org/10.1093/eurheartj/ehab537
Publication status	Published - 1 Apr 2022

Bibliographical note

Funding:
The SYNTAX Extended Survival study was supported by the German
Foundation of Heart Research (Frankfurt am Main, Germany). The
SYNTAX trial, during 0- to 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. C.G. is supported by Science Foundation
Ireland award (15/RP/2765).

Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

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Single or multiple arterial bypass graft surgeryFinal published version, 1.09 MBLicence: CC BY-NC

Cite this

Davierwala, P. M., Gao, C., Thuijs, D. J. F. M., Wang, R., Hara, H., Ono, M., Noack, T., Garg, S., O'Leary, N., Milojevic, M., Kappetein, A. P., Morice, M. C., Mack, M. J., Van Geuns, R. J., Holmes, D. R., Gaudino, M., Taggart, D. P., Onuma, Y., Mohr, F. W., & Serruys, P. W. (2022). Single or multiple arterial bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel or left main coronary artery disease. European Heart Journal, 43(13), 1334-1344. https://doi.org/10.1093/eurheartj/ehab537

@article{d004cc6114a84178b1d4ab29c823ebfd,

title = "Single or multiple arterial bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel or left main coronary artery disease",

abstract = "Aim: The aim of this study was to compare long-term all-cause mortality between patients receiving percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using multiple (MAG) or single arterial grafting (SAG). Methods and results: The current study is a post hoc analysis of the SYNTAX Extended Survival Study, which compared PCI with CABG in patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD) and evaluated survival with ≥10 years of follow-up. The primary endpoint was all-cause mortality at maximum follow-up (median 11.9 years) assessed in the as-treated population. Of the 1743 patients, 901 (51.7%) underwent PCI, 532 (30.5%) received SAG, and 310 (17.8%) had MAG. At maximum follow-up, all-cause death occurred in 305 (33.9%), 175 (32.9%), and 70 (22.6%) patients in the PCI, SAG, and MAG groups, respectively (P < 0.001). Multiple arterial grafting [adjusted hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.49-0.89], but not SAG (adjusted HR 0.83, 95% CI 0.67-1.03), was associated with significantly lower all-cause mortality compared with PCI. In patients with 3VD, both MAG (adjusted HR 0.55, 95% CI 0.37-0.81) and SAG (adjusted HR 0.68, 95% CI 0.50-0.91) were associated with significantly lower mortality than PCI, whereas in LMCAD patients, no significant differences between PCI and MAG (adjusted HR 0.90, 95% CI 0.56-1.46) or SAG (adjusted HR 1.11, 95% CI 0.81-1.53) were observed. In patients with revascularization of all three major myocardial territories, a positive correlation was observed between the number of myocardial territories receiving arterial grafts and survival (Ptrend = 0.003). Conclusion: Our findings suggest that MAG might be the more desirable configuration for CABG to achieve lower long-term all-cause mortality than PCI in patients with 3VD and/or LMCAD. Trial registration: Registered on clinicaltrial.gov. SYNTAXES: NCT03417050 (https://clinicaltrials.gov/ct2/show/NCT03417050); SYNTAX: NCT00114972 (https://www.clinicaltrials.gov/ct2/show/NCT00114972).",

author = "Davierwala, {Piroze M.} and Chao Gao and Thuijs, {Daniel J.F.M.} and Rutao Wang and Hironori Hara and Masafumi Ono and Thilo Noack and Scot Garg and Neil O'Leary and Milan Milojevic and Kappetein, {Arie Pieter} and Morice, {Marie Claude} and Mack, {Michael J.} and {Van Geuns}, {Robert Jan} and Holmes, {David R.} and Mario Gaudino and Taggart, {David P.} and Yoshinobu Onuma and Mohr, {Friedrich Wilhelm} and Serruys, {Patrick W.}",

note = "Funding: The SYNTAX Extended Survival study was supported by the German Foundation of Heart Research (Frankfurt am Main, Germany). The SYNTAX trial, during 0- to 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. C.G. is supported by Science Foundation Ireland award (15/RP/2765). Publisher Copyright: {\textcopyright} 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2022",

month = apr,

day = "1",

doi = "10.1093/eurheartj/ehab537",

language = "English",

volume = "43",

pages = "1334--1344",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

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Davierwala, PM, Gao, C, Thuijs, DJFM, Wang, R, Hara, H, Ono, M, Noack, T, Garg, S, O'Leary, N, Milojevic, M, Kappetein, AP, Morice, MC, Mack, MJ, Van Geuns, RJ, Holmes, DR, Gaudino, M, Taggart, DP, Onuma, Y, Mohr, FW & Serruys, PW 2022, 'Single or multiple arterial bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel or left main coronary artery disease', European Heart Journal, vol. 43, no. 13, pp. 1334-1344. https://doi.org/10.1093/eurheartj/ehab537

Single or multiple arterial bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel or left main coronary artery disease. / Davierwala, Piroze M.; Gao, Chao; Thuijs, Daniel J.F.M. et al.
In: European Heart Journal, Vol. 43, No. 13, 01.04.2022, p. 1334-1344.

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

TY - JOUR

T1 - Single or multiple arterial bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel or left main coronary artery disease

AU - Davierwala, Piroze M.

AU - Gao, Chao

AU - Thuijs, Daniel J.F.M.

AU - Wang, Rutao

AU - Hara, Hironori

AU - Ono, Masafumi

AU - Noack, Thilo

AU - Garg, Scot

AU - O'Leary, Neil

AU - Milojevic, Milan

AU - Kappetein, Arie Pieter

AU - Morice, Marie Claude

AU - Mack, Michael J.

AU - Van Geuns, Robert Jan

AU - Holmes, David R.

AU - Gaudino, Mario

AU - Taggart, David P.

AU - Onuma, Yoshinobu

AU - Mohr, Friedrich Wilhelm

AU - Serruys, Patrick W.

N1 - Funding: The SYNTAX Extended Survival study was supported by the German Foundation of Heart Research (Frankfurt am Main, Germany). The SYNTAX trial, during 0- to 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. C.G. is supported by Science Foundation Ireland award (15/RP/2765). Publisher Copyright: © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2022/4/1

Y1 - 2022/4/1

N2 - Aim: The aim of this study was to compare long-term all-cause mortality between patients receiving percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using multiple (MAG) or single arterial grafting (SAG). Methods and results: The current study is a post hoc analysis of the SYNTAX Extended Survival Study, which compared PCI with CABG in patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD) and evaluated survival with ≥10 years of follow-up. The primary endpoint was all-cause mortality at maximum follow-up (median 11.9 years) assessed in the as-treated population. Of the 1743 patients, 901 (51.7%) underwent PCI, 532 (30.5%) received SAG, and 310 (17.8%) had MAG. At maximum follow-up, all-cause death occurred in 305 (33.9%), 175 (32.9%), and 70 (22.6%) patients in the PCI, SAG, and MAG groups, respectively (P < 0.001). Multiple arterial grafting [adjusted hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.49-0.89], but not SAG (adjusted HR 0.83, 95% CI 0.67-1.03), was associated with significantly lower all-cause mortality compared with PCI. In patients with 3VD, both MAG (adjusted HR 0.55, 95% CI 0.37-0.81) and SAG (adjusted HR 0.68, 95% CI 0.50-0.91) were associated with significantly lower mortality than PCI, whereas in LMCAD patients, no significant differences between PCI and MAG (adjusted HR 0.90, 95% CI 0.56-1.46) or SAG (adjusted HR 1.11, 95% CI 0.81-1.53) were observed. In patients with revascularization of all three major myocardial territories, a positive correlation was observed between the number of myocardial territories receiving arterial grafts and survival (Ptrend = 0.003). Conclusion: Our findings suggest that MAG might be the more desirable configuration for CABG to achieve lower long-term all-cause mortality than PCI in patients with 3VD and/or LMCAD. Trial registration: Registered on clinicaltrial.gov. SYNTAXES: NCT03417050 (https://clinicaltrials.gov/ct2/show/NCT03417050); SYNTAX: NCT00114972 (https://www.clinicaltrials.gov/ct2/show/NCT00114972).

AB - Aim: The aim of this study was to compare long-term all-cause mortality between patients receiving percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using multiple (MAG) or single arterial grafting (SAG). Methods and results: The current study is a post hoc analysis of the SYNTAX Extended Survival Study, which compared PCI with CABG in patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD) and evaluated survival with ≥10 years of follow-up. The primary endpoint was all-cause mortality at maximum follow-up (median 11.9 years) assessed in the as-treated population. Of the 1743 patients, 901 (51.7%) underwent PCI, 532 (30.5%) received SAG, and 310 (17.8%) had MAG. At maximum follow-up, all-cause death occurred in 305 (33.9%), 175 (32.9%), and 70 (22.6%) patients in the PCI, SAG, and MAG groups, respectively (P < 0.001). Multiple arterial grafting [adjusted hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.49-0.89], but not SAG (adjusted HR 0.83, 95% CI 0.67-1.03), was associated with significantly lower all-cause mortality compared with PCI. In patients with 3VD, both MAG (adjusted HR 0.55, 95% CI 0.37-0.81) and SAG (adjusted HR 0.68, 95% CI 0.50-0.91) were associated with significantly lower mortality than PCI, whereas in LMCAD patients, no significant differences between PCI and MAG (adjusted HR 0.90, 95% CI 0.56-1.46) or SAG (adjusted HR 1.11, 95% CI 0.81-1.53) were observed. In patients with revascularization of all three major myocardial territories, a positive correlation was observed between the number of myocardial territories receiving arterial grafts and survival (Ptrend = 0.003). Conclusion: Our findings suggest that MAG might be the more desirable configuration for CABG to achieve lower long-term all-cause mortality than PCI in patients with 3VD and/or LMCAD. Trial registration: Registered on clinicaltrial.gov. SYNTAXES: NCT03417050 (https://clinicaltrials.gov/ct2/show/NCT03417050); SYNTAX: NCT00114972 (https://www.clinicaltrials.gov/ct2/show/NCT00114972).

UR - http://www.scopus.com/inward/record.url?scp=85124829878&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehab537

DO - 10.1093/eurheartj/ehab537

M3 - Article

C2 - 34405875

AN - SCOPUS:85124829878

SN - 0195-668X

VL - 43

SP - 1334

EP - 1344

JO - European Heart Journal

JF - European Heart Journal

IS - 13

ER -

Single or multiple arterial bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel or left main coronary artery disease

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