Impact of chronic obstructive pulmonary disease on 10-year mortality after percutaneous coronary intervention and bypass surgery for complex coronary artery disease: insights from the SYNTAX Extended Survival study.

Abstract

AIMS:

To evaluate the impact of chronic obstructive pulmonary disease (COPD) on 10-year all-cause death and the treatment effect of CABG versus PCI on 10-year all-cause death in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) and COPD.

METHODS:

Patients were stratified according to COPD status and compared with regard to clinical outcomes. Ten-year all-cause death was examined according to the presence of COPD and the revascularization strategy.

RESULTS:

COPD status was available for all randomized 1800 patients, of whom, 154 had COPD (8.6%) at the time of randomization. Regardless of the revascularization strategy, patients with COPD had a higher risk of 10-year all-cause death, compared with those without COPD (43.1% vs. 24.9%; hazard ratio [HR]: 2.03; 95% confidence interval [CI]: 1.56-2.64; p < 0.001). Among patients with COPD, CABG appeared to have a slightly lower risk of 10-year all-cause death compared with PCI (42.3% vs. 43.9%; HR: 0.96; 95% CI: 0.59-1.56, p = 0.858), whereas among those without COPD, CABG had a significantly lower risk of 10-year all-cause death (22.7% vs. 27.1%; HR: 0.81; 95% CI: 0.67-0.99, p = 0.041). There was no significant differential treatment effect of CABG versus PCI on 10-year all-cause death between patients with and without COPD (p interaction = 0.544).

CONCLUSIONS:

COPD was associated with a higher risk of 10-year all-cause death after revascularization for complex coronary artery disease. The presence of COPD did not significantly modify the beneficial effect of CABG versus PCI on 10-year all-cause death.

TRIAL REGISTRATION:

SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.

• Authors: Rutao Wang, Mariusz Tomaniak, Kuniaki Takahashi, Chao Gao, Hideyuki Kawashima, Hironori Hara, Masafumi Ono, David van Klaveren, Robert-Jan van Geuns, Marie-Claude Morice, Piroze M Davierwala, Michael J Mack, Adam Witkowski, Nick Curzen, Sergio Berti, Francesco Burzotta, Stefan James, Arie Pieter Kappetein, Stuart J Head, Daniel J F M Thuijs, Friedrich W Mohr, David R Holmes, Ling Tao, Yoshinobu Onuma, Patrick W Serruys
• Journal: Clinical research in cardiology : official journal of the German Cardiac Society (Clin Res Cardiol) Vol. 110 Issue 7 Pg. 1083-1095 (Jul 2021) ISSN: 1861-0692 [Electronic] Germany
• PMID: 33710385 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Topics

• Aged
• Cause of Death (trends)
• Coronary Artery Bypass (methods)
• Coronary Artery Disease (complications, mortality, surgery)
• Drug-Eluting Stents
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Netherlands (epidemiology)
• Percutaneous Coronary Intervention (methods)
• Postoperative Period
• Pulmonary Disease, Chronic Obstructive (complications, mortality)
• Retrospective Studies
• Risk Factors
• Survival Rate (trends)
• Time Factors