Impact of major infections on 10-year mortality after revascularization in patients with complex coronary artery disease.

Abstract

BACKGROUND:

The significant interaction between major infection and 5-year mortality after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) for complex coronary artery disease (CAD) was observed previously. However, the very long-term outcomes beyond 5 years remains unclear.

METHODS AND RESULTS:

This is a subgroup analysis of the SYNTAX Extended Survival (SYNTAXES) trial, which is the extended follow-up of the randomized SYNTAX trial comparing PCI versus CABG in patients with three-vessel disease (3VD) or left-main CAD (LMCAD). Out of 1517 patients enrolled in the SYNTAX trial with available survival status from 5 to 10 years, 140 patients had experienced major infections and survived at 5 years (major infection group). From 5 to 10 years, the mortality of major infection group was 19.8% whereas the mortality of no major infection group was 15.1% (p = 0.157). After the adjustment of other clinical factors, the risk of mortality from 5 to 10 years did not significantly differ between major infection and no major infection groups (HR: 1.10; 95% CI: 0.62-1.96; p = 0.740). When stratified by the presence or absence of periprocedural major infections, defined as a major infection within 60 days after index procedure, there was also no significant difference in 10-year mortality between two groups (30.8% vs. 24.5%; p = 0.057).

CONCLUSIONS:

Despite the initial association between major infections and 5 years mortality, postprocedural major infection was not evident in the 10 years follow-up, suggesting that the impact of major infection on mortality subsided over time beyond 5 years.

TRIAL REGISTRATION:

SYNTAXES ClinicalTrials.gov reference: NCT03417050 SYNTAX ClinicalTrials.gov reference: NCT00114972.

• Authors: Masafumi Ono, Hideyuki Kawashima, Hironori Hara, Massimo Mancone, Michael J Mack, David R Holmes, Marie-Claude Morice, Arie Pieter Kappetein, Daniel J F M Thuijs, Thilo Noack, Friedrich W Mohr, Piroze M Davierwala, Yoshinobu Onuma, Patrick W Serruys, SYNTAX Extended Survival Investigators
• Journal: International journal of cardiology (Int J Cardiol) Vol. 341 Pg. 9-12 (Oct 15 2021) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 34375706 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

Topics

• Coronary Artery Bypass
• Coronary Artery Disease (diagnostic imaging, surgery)
• Follow-Up Studies
• Humans
• Percutaneous Coronary Intervention (adverse effects)
• Treatment Outcome
• Vascular Surgical Procedures