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.

• Authors: 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 Jr, Patrick W Serruys
• Journal: Clinical research in cardiology : official journal of the German Cardiac Society (Clin Res Cardiol) Vol. 110 Issue 10 Pg. 1543-1553 (Oct 2021) ISSN: 1861-0692 [Electronic] Germany
• PMID: 33517534 (Publication Type: Controlled Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: © 2021. The Author(s).

Topics

• Aged
• Cause of Death
• Cerebrovascular Disorders (complications, mortality)
• Coronary Artery Bypass (methods)
• Coronary Artery Disease (mortality, surgery)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Myocardial Revascularization (methods)
• Percutaneous Coronary Intervention (methods)
• Risk Factors