Impact of established cardiovascular disease on 10-year death after coronary revascularization for complex coronary artery disease,Clinical Research in Cardiology

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Impact of established cardiovascular disease on 10-year death after coronary revascularization for complex coronary artery disease
Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-08-25 , DOI: 10.1007/s00392-021-01922-y
Rutao Wang _{1,

2,

3} , Scot Garg ₄ , Chao Gao _{1,

2,

3} , Hideyuki Kawashima _{2,

5} , Masafumi Ono _{2,

5} , Hironori Hara _{2,

5} , Robert-Jan van Geuns ₃ , Marie-Claude Morice ₆ , Piroze M Davierwala ₇ , Arie Pieter Kappetein ₈ , David R Holmes ₉ , William Wijns ₂ , Ling Tao ₁ , Yoshinobu Onuma ₂ , Patrick W Serruys _{2,

10}

Affiliation

Aims

To investigate the impact of established cardiovascular disease (CVD) on 10-year all-cause death following coronary revascularization in patients with complex coronary artery disease (CAD).

Methods

The SYNTAXES study assessed vital status out to 10 years of patients with complex CAD enrolled in the SYNTAX trial. The relative efficacy of PCI versus CABG in terms of 10-year all-cause death was assessed according to co-existing CVD.

Results

Established CVD status was recorded in 1771 (98.3%) patients, of whom 827 (46.7%) had established CVD. Compared to those without CVD, patients with CVD had a significantly higher risk of 10-year all-cause death (31.4% vs. 21.7%; adjusted HR: 1.40; 95% CI 1.08–1.80, p = 0.010). In patients with CVD, PCI had a non-significant numerically higher risk of 10-year all-cause death compared with CABG (35.9% vs. 27.2%; adjusted HR: 1.14; 95% CI 0.83–1.58, p = 0.412). The relative treatment effects of PCI versus CABG on 10-year all-cause death in patients with complex CAD were similar irrespective of the presence of CVD (p_-interaction = 0.986). Only those patients with CVD in ≥ 2 territories had a higher risk of 10-year all-cause death (adjusted HR: 2.99, 95% CI 2.11–4.23, p < 0.001) compared to those without CVD.

Conclusions

The presence of CVD involving more than one territory was associated with a significantly increased risk of 10-year all-cause death, which was non-significantly higher in complex CAD patients treated with PCI compared with CABG. Acceptable long-term outcomes were observed, suggesting that patients with established CVD should not be precluded from undergoing invasive angiography or revascularization.

Trial registration

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

Graphic abstract

中文翻译：

复杂冠状动脉疾病冠状动脉血运重建术后已确诊的心血管疾病对 10 年死亡的影响

目标

旨在调查复杂冠状动脉疾病 (CAD) 患者冠状动脉血运重建后已确诊的心血管疾病 (CVD) 对 10 年全因死亡的影响。

方法

SYNTAXES 研究评估了参加 SYNTAX 试验的复杂 CAD 患者 10 年来的生命状态。根据共存 CVD 评估 PCI 与 CABG 在 10 年全因死亡方面的相对疗效。

结果

1771 名 (98.3%) 患者记录了已确诊的 CVD 状态，其中 827 名 (46.7%) 已确诊 CVD。与无 CVD 的患者相比，患有 CVD 的患者 10 年全因死亡的风险显着更高（31.4% vs. 21.7%；调整后 HR：1.40；95% CI 1.08–1.80， p = 0.010）。在 CVD 患者中，与 CABG 相比，PCI 的 10 年全因死亡风险在数值上不显着较高（35.9% vs. 27.2%；调整后 HR：1.14；95% CI 0.83–1.58， p = 0.412）。无论是否存在 CVD，PCI 与 CABG 对复杂 CAD 患者 10 年全因死亡的相对治疗效果相似（ p_交互作用= 0.986）。与无 CVD 的患者相比，只有 ≥ 2 个地区患有 CVD 的患者 10 年全因死亡风险较高（调整后 HR：2.99，95% CI 2.11–4.23， p < 0.001）。