Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization.
All-cause death
Coronary artery bypass grafting
Percutaneous coronary intervention
Repeat revascularization
SYNTAX
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
28
01
2023
accepted:
17
04
2023
medline:
25
8
2023
pubmed:
8
5
2023
entrez:
7
5
2023
Statut:
ppublish
Résumé
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. 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. 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). 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. URL: https://www. gov ; SYNTAXES Unique identifier: NCT03417050. URL: https://www. gov ; SYNTAX Unique identifier: NCT00114972.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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
BACKGROUND
URL: https://www.
CLINICALTRIALS
RESULTS
gov ; SYNTAXES Unique identifier: NCT03417050. URL: https://www.
CLINICALTRIALS
RESULTS
gov ; SYNTAX Unique identifier: NCT00114972.
Identifiants
pubmed: 37150783
doi: 10.1007/s00392-023-02211-6
pii: 10.1007/s00392-023-02211-6
pmc: PMC10449944
doi:
Banques de données
ClinicalTrials.gov
['NCT03417050', 'NCT00114972']
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1302-1311Subventions
Organisme : Science Foundation Ireland
ID : Research Professorship Grant 15/RP/2765
Pays : Ireland
Informations de copyright
© 2023. The Author(s).
Références
Am Heart J. 2006 Jun;151(6):1194-204
pubmed: 16781219
J Am Coll Cardiol. 2015 Dec 15;66(23):2648-2662
pubmed: 26670066
JACC Cardiovasc Interv. 2008 Feb;1(1):65-71
pubmed: 19393147
J Am Coll Cardiol. 2004 May 19;43(10):1743-51
pubmed: 15145093
Circ Cardiovasc Interv. 2008 Dec;1(3):193-200
pubmed: 20031678
Eur Heart J. 2019 Jan 7;40(2):87-165
pubmed: 30165437
JACC Cardiovasc Interv. 2018 May 14;11(9):892-902
pubmed: 29680221
Mayo Clin Proc. 2019 Sep;94(9):1743-1752
pubmed: 31486379
Circulation. 2021 Jul 13;144(2):96-109
pubmed: 34011163
J Am Coll Cardiol. 2005 Aug 16;46(4):575-81
pubmed: 16098418
J Cardiothorac Surg. 2011 Sep 10;6:107
pubmed: 21906320
J Am Coll Cardiol. 2009 Jun 23;53(25):2324-31
pubmed: 19539141
JACC Cardiovasc Interv. 2016 Dec 26;9(24):2493-2507
pubmed: 28007201
J Am Coll Cardiol. 2019 Dec 24;74(25):3164-3173
pubmed: 31856974
J Am Coll Cardiol. 2001 Jan;37(1):51-8
pubmed: 11153772
JACC Cardiovasc Interv. 2020 Feb 10;13(3):375-387
pubmed: 31954680
N Engl J Med. 2011 May 5;364(18):1718-27
pubmed: 21463149
J Am Coll Cardiol. 1999 Sep;34(3):618-20
pubmed: 10483939
JACC Cardiovasc Interv. 2020 Oct 12;13(19):2266-2274
pubmed: 33032714
Lancet. 2019 Oct 12;394(10206):1325-1334
pubmed: 31488373
Eur Heart J. 2021 Dec 28;43(1):56-67
pubmed: 34405232
Lancet. 2013 Feb 23;381(9867):629-38
pubmed: 23439102
J Am Coll Cardiol. 2014 Apr 29;63(16):1617-25
pubmed: 24530680
Lancet. 2013 Feb 23;381(9867):605-7
pubmed: 23439089
Circulation. 2022 Jan 18;145(3):e18-e114
pubmed: 34882435
N Engl J Med. 2009 Mar 5;360(10):961-72
pubmed: 19228612
J Am Coll Cardiol. 2019 Nov 5;74(18):2238-2248
pubmed: 31672179
Lancet. 2004 Aug 14-20;364(9434):583-91
pubmed: 15313358