Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study

Rutao Wang; Kuniaki Takahashi; Scot Garg; Daniel J.F.M. Thuijs; Arie Pieter Kappetein; Michael J. Mack; Marie Claude Morice; Friedrich Wilhelm Mohr; Nick Curzen; Piroze Davierwala; Milan Milojevic; Robert Jan van Geuns; Stuart J. Head; Yoshinobu Onuma; David R. Holmes; Patrick W. Serruys

doi:10.1007/s00392-020-01802-x

Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study

Rutao Wang, Kuniaki Takahashi, Scot Garg, Daniel J.F.M. Thuijs, Arie Pieter Kappetein, Michael J. Mack, Marie Claude Morice, Friedrich Wilhelm Mohr, Nick Curzen, Piroze Davierwala, Milan Milojevic, Robert Jan van Geuns, Stuart J. Head, Yoshinobu Onuma, David R. Holmes, Patrick W. Serruys^*

^*Corresponding author for this work

Cardiothoracic Surgery

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

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Abstract

Background: Coronary bypass artery grafting (CABG) has a higher procedural risk of stroke than percutaneous coronary intervention (PCI), but may offer better long-term survival. The optimal revascularization strategy for patients with prior cerebrovascular disease (CEVD) remains unclear. Methods and results: The SYNTAXES study assessed the vital status out to 10 year of patients with three-vessel disease and/or left main coronary artery disease enrolled in the SYNTAX trial. The relative efficacy of PCI vs. CABG in terms of 10 year all-cause death was assessed according to prior CEVD. The primary endpoint was 10 year all-cause death. The status of prior CEVD was available in 1791 (99.5%) patients, of whom 253 patients had prior CEVD. Patients with prior CEVD were older and had more comorbidities (medically treated diabetes, insulin-dependent diabetes, metabolic syndrome, peripheral vascular disease, chronic obstructive pulmonary disease, impaired renal function, and congestive heart failure), compared with those without prior CEVD. Prior CEVD was an independent predictor of 10 year all-cause death (adjusted HR: 1.35; 95% CI: 1.04–1.73; p = 0.021). Patients with prior CEVD had a significantly higher risk of 10 year all-cause death (41.1 vs. 24.1%; HR: 1.92; 95% CI: 1.54–2.40; p < 0.001). The risk of 10 year all-cause death was similar between patients receiving PCI or CABG irrespective of the presence of prior CEVD (p_-interaction = 0.624). Conclusion: Prior CEVD was associated with a significantly increased risk of 10 year all-cause death which was similar in patients treated with PCI or CABG. These results do not support preferential referral for PCI rather than CABG in patients with prior CEVD. Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract: [Figure not available: see fulltext.].

Original language	English
Pages (from-to)	1543-1553
Number of pages	11
Journal	Clinical Research in Cardiology
Volume	110
Issue number	10
Early online date	30 Jan 2021
DOIs	https://doi.org/10.1007/s00392-020-01802-x
Publication status	Published - Oct 2021

Bibliographical note

Funding Information:
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.

Publisher Copyright:
© 2021, The Author(s).

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Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular diseaseFinal published version, 0.98 MBLicence: CC BY

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Wang, R., Takahashi, K., Garg, S., Thuijs, D. J. F. M., Kappetein, A. P., Mack, M. J., Morice, M. C., Mohr, F. W., Curzen, N., Davierwala, P., Milojevic, M., van Geuns, R. J., Head, S. J., Onuma, Y., Holmes, D. R., & Serruys, P. W. (2021). Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study. Clinical Research in Cardiology, 110(10), 1543-1553. https://doi.org/10.1007/s00392-020-01802-x

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title = "Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study",

abstract = "Background: Coronary bypass artery grafting (CABG) has a higher procedural risk of stroke than percutaneous coronary intervention (PCI), but may offer better long-term survival. The optimal revascularization strategy for patients with prior cerebrovascular disease (CEVD) remains unclear. Methods and results: The SYNTAXES study assessed the vital status out to 10 year of patients with three-vessel disease and/or left main coronary artery disease enrolled in the SYNTAX trial. The relative efficacy of PCI vs. CABG in terms of 10 year all-cause death was assessed according to prior CEVD. The primary endpoint was 10 year all-cause death. The status of prior CEVD was available in 1791 (99.5%) patients, of whom 253 patients had prior CEVD. Patients with prior CEVD were older and had more comorbidities (medically treated diabetes, insulin-dependent diabetes, metabolic syndrome, peripheral vascular disease, chronic obstructive pulmonary disease, impaired renal function, and congestive heart failure), compared with those without prior CEVD. Prior CEVD was an independent predictor of 10 year all-cause death (adjusted HR: 1.35; 95% CI: 1.04–1.73; p = 0.021). Patients with prior CEVD had a significantly higher risk of 10 year all-cause death (41.1 vs. 24.1%; HR: 1.92; 95% CI: 1.54–2.40; p < 0.001). The risk of 10 year all-cause death was similar between patients receiving PCI or CABG irrespective of the presence of prior CEVD (p-interaction = 0.624). Conclusion: Prior CEVD was associated with a significantly increased risk of 10 year all-cause death which was similar in patients treated with PCI or CABG. These results do not support preferential referral for PCI rather than CABG in patients with prior CEVD. Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract: [Figure not available: see fulltext.].",

author = "Rutao Wang and Kuniaki Takahashi and Scot Garg and Thuijs, {Daniel J.F.M.} and Kappetein, {Arie Pieter} and Mack, {Michael J.} and Morice, {Marie Claude} and Mohr, {Friedrich Wilhelm} and Nick Curzen and Piroze Davierwala and Milan Milojevic and {van Geuns}, {Robert Jan} and Head, {Stuart J.} and Yoshinobu Onuma and Holmes, {David R.} and Serruys, {Patrick W.}",

note = "Funding Information: 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. Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2021",

month = oct,

doi = "10.1007/s00392-020-01802-x",

language = "English",

volume = "110",

pages = "1543--1553",

journal = "Clinical Research in Cardiology",

issn = "1861-0684",

publisher = "D. Steinkopff-Verlag",

number = "10",

}

Wang, R, Takahashi, K, Garg, S, Thuijs, DJFM, Kappetein, AP, Mack, MJ, Morice, MC, Mohr, FW, Curzen, N, Davierwala, P, Milojevic, M, van Geuns, RJ, Head, SJ, Onuma, Y, Holmes, DR & Serruys, PW 2021, 'Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study', Clinical Research in Cardiology, vol. 110, no. 10, pp. 1543-1553. https://doi.org/10.1007/s00392-020-01802-x

Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study. / Wang, Rutao; Takahashi, Kuniaki; Garg, Scot et al.
In: Clinical Research in Cardiology, Vol. 110, No. 10, 10.2021, p. 1543-1553.

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

TY - JOUR

T1 - Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease

T2 - insights from the SYNTAX Extended Survival study

AU - Wang, Rutao

AU - Takahashi, Kuniaki

AU - Garg, Scot

AU - Thuijs, Daniel J.F.M.

AU - Kappetein, Arie Pieter

AU - Mack, Michael J.

AU - Morice, Marie Claude

AU - Mohr, Friedrich Wilhelm

AU - Curzen, Nick

AU - Davierwala, Piroze

AU - Milojevic, Milan

AU - van Geuns, Robert Jan

AU - Head, Stuart J.

AU - Onuma, Yoshinobu

AU - Holmes, David R.

AU - Serruys, Patrick W.

N1 - Funding Information: 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. Publisher Copyright: © 2021, The Author(s).

PY - 2021/10

Y1 - 2021/10

N2 - Background: Coronary bypass artery grafting (CABG) has a higher procedural risk of stroke than percutaneous coronary intervention (PCI), but may offer better long-term survival. The optimal revascularization strategy for patients with prior cerebrovascular disease (CEVD) remains unclear. Methods and results: The SYNTAXES study assessed the vital status out to 10 year of patients with three-vessel disease and/or left main coronary artery disease enrolled in the SYNTAX trial. The relative efficacy of PCI vs. CABG in terms of 10 year all-cause death was assessed according to prior CEVD. The primary endpoint was 10 year all-cause death. The status of prior CEVD was available in 1791 (99.5%) patients, of whom 253 patients had prior CEVD. Patients with prior CEVD were older and had more comorbidities (medically treated diabetes, insulin-dependent diabetes, metabolic syndrome, peripheral vascular disease, chronic obstructive pulmonary disease, impaired renal function, and congestive heart failure), compared with those without prior CEVD. Prior CEVD was an independent predictor of 10 year all-cause death (adjusted HR: 1.35; 95% CI: 1.04–1.73; p = 0.021). Patients with prior CEVD had a significantly higher risk of 10 year all-cause death (41.1 vs. 24.1%; HR: 1.92; 95% CI: 1.54–2.40; p < 0.001). The risk of 10 year all-cause death was similar between patients receiving PCI or CABG irrespective of the presence of prior CEVD (p-interaction = 0.624). Conclusion: Prior CEVD was associated with a significantly increased risk of 10 year all-cause death which was similar in patients treated with PCI or CABG. These results do not support preferential referral for PCI rather than CABG in patients with prior CEVD. Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract: [Figure not available: see fulltext.].

AB - Background: Coronary bypass artery grafting (CABG) has a higher procedural risk of stroke than percutaneous coronary intervention (PCI), but may offer better long-term survival. The optimal revascularization strategy for patients with prior cerebrovascular disease (CEVD) remains unclear. Methods and results: The SYNTAXES study assessed the vital status out to 10 year of patients with three-vessel disease and/or left main coronary artery disease enrolled in the SYNTAX trial. The relative efficacy of PCI vs. CABG in terms of 10 year all-cause death was assessed according to prior CEVD. The primary endpoint was 10 year all-cause death. The status of prior CEVD was available in 1791 (99.5%) patients, of whom 253 patients had prior CEVD. Patients with prior CEVD were older and had more comorbidities (medically treated diabetes, insulin-dependent diabetes, metabolic syndrome, peripheral vascular disease, chronic obstructive pulmonary disease, impaired renal function, and congestive heart failure), compared with those without prior CEVD. Prior CEVD was an independent predictor of 10 year all-cause death (adjusted HR: 1.35; 95% CI: 1.04–1.73; p = 0.021). Patients with prior CEVD had a significantly higher risk of 10 year all-cause death (41.1 vs. 24.1%; HR: 1.92; 95% CI: 1.54–2.40; p < 0.001). The risk of 10 year all-cause death was similar between patients receiving PCI or CABG irrespective of the presence of prior CEVD (p-interaction = 0.624). Conclusion: Prior CEVD was associated with a significantly increased risk of 10 year all-cause death which was similar in patients treated with PCI or CABG. These results do not support preferential referral for PCI rather than CABG in patients with prior CEVD. Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract: [Figure not available: see fulltext.].

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U2 - 10.1007/s00392-020-01802-x

DO - 10.1007/s00392-020-01802-x

M3 - Article

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AN - SCOPUS:85099909811

SN - 1861-0684

VL - 110

SP - 1543

EP - 1553

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

IS - 10

ER -

Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study

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