Background:Clinical and anatomical characteristics are often considered key factors in deciding between percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with complex coronary artery disease (CAD) such as left-main CAD or 3-vessel disease. However, little is known about the interaction between self-reported preprocedural physical/mental health and clinical outcomes after revascularization.Methods:This subgroup analysis of the SYNTAXES trial (SYNTAX Extended Survival), which is the extended follow-up of the randomized SYNTAX trial (Synergy Between PCI With Taxus and Cardiac Surgery) comparing PCI with CABG in patients with left-main CAD or 3-vessel disease, stratified patients by terciles of Physical (PCS) or Mental Component Summary (MCS) scores derived from the preprocedural 36-Item Short Form Health Survey, with higher PCS and MCS scores representing better physical and mental health, respectively. The primary end point was all-cause death at 10 years.Results:A total of 1656 patients with preprocedural 36-Item Short Form Health Survey data were included in the present study. Both higher PCS and MCS were independently associated with lower 10-year mortality (10-point increase in PCS adjusted hazard ratio, 0.84 [95% CI, 0.73–0.97]; P=0.021; in MCS adjusted hazard ratio, 0.85 [95% CI, 0.76–0.95]; P=0.005). A significant survival benefit with CABG over PCI was observed in the highest PCS (>45.5) and MCS (>52.3) terciles with significant treatment-by-subgroup interactions (PCS P_interaction=0.033, MCS P_interaction=0.015). In patients with both high PCS (>45.5) and MCS (>52.3), 10-year mortality was significantly higher with PCI compared with CABG (30.5% versus 12.2%; hazard ratio, 2.87 [95% CI, 1.55–5.30]; P=0.001), whereas among those with low PCS (≤45.5) or low MCS (≤52.3), there were no significant differences in 10-year mortality between PCI and CABG, resulting in a significant treatment-by-subgroup interaction (P_interaction=0.002).Conclusions:Among patients with left-main CAD or 3-vessel disease, patient-reported preprocedural physical and mental health status was strongly associated with long-term mortality and modified the relative treatment effects of PCI versus CABG. Patients with the best physical and mental health had better 10-year survival with CABG compared with PCI. Assessment of self-reported physical and mental health is important when selecting the optimal revascularization strategy.Registration:URL: https://www.clinicaltrials.gov; SYNTAXES Unique identifier: NCT03417050. URL: https://www.clinicaltrials.gov; SYNTAX Unique identifier: NCT00114972.

中文翻译：

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患者报告的术前身心健康对经皮或外科冠状动脉血运重建术后 10 年死亡率的影响

背景：临床和解剖学特征通常被认为是决定复杂冠状动脉疾病 (CAD)（如左主干 CAD 或 3 支血管疾病）患者选择经皮冠状动脉介入治疗 (PCI) 还是冠状动脉旁路移植术 (CABG) 的关键因素。然而，关于自我报告的术前身体/心理健康与血运重建后临床结果之间的相互作用知之甚少。方法：对 SYNTAXES 试验（SYNTAX Extended Survival）的亚组分析，这是随机 SYNTAX 试验的扩展随访（PCI 与红豆杉和心脏手术之间的协同作用）比较 PCI 与 CABG 治疗左主干 CAD 或 3 支血管疾病的患者，根据程序前 36 项简短健康调查得出的身体 (PCS) 或心理成分总结 (MCS) 分数的三分位数对患者进行分层，较高的 PCS 和 MCS 分数分别代表更好的身体和心理健康。主要终点是 10 年时的全因死亡。结果：本研究共纳入 1656 名患者，包括术前 36 项简短健康调查数据。较高的 PCS 和 MCS 均与较低的 10 年死亡率独立相关（PCS 调整后的风险比增加 10 点，0.84 [95% CI，0.73–0.97]；本研究共纳入 1656 名具有术前 36 项简短健康调查数据的患者。较高的 PCS 和 MCS 均与较低的 10 年死亡率独立相关（PCS 调整后的风险比增加 10 点，0.84 [95% CI，0.73–0.97]；本研究共纳入 1656 名具有术前 36 项简短健康调查数据的患者。较高的 PCS 和 MCS 均与较低的 10 年死亡率独立相关（PCS 调整后的风险比增加 10 点，0.84 [95% CI，0.73–0.97]；P = 0.021；在 MCS 调整后的风险比中，0.85 [95% CI，0.76–0.95]；P = 0.005)。在最高 PCS (>45.5) 和 MCS (>52.3) 的三分位数中观察到 CABG 比 PCI 有显着的生存获益，并具有显着的亚组交互作用（PCS P_交互作用=0.033，MCS P_交互作用=0.015）。在同时具有高 PCS (>45.5) 和 MCS (>52.3) 的患者中，PCI 的 10 年死亡率显着高于 CABG（30.5% 对 12.2%；风险比，2.87 [95% CI，1.55–5.30]；P = 0.001），而在 PCS 低（≤45.5）或 MCS 低（≤52.3）的患者中，PCI 和 CABG 之间的 10 年死亡率没有显着差异，导致治疗与亚组之间存在显着的交互作用（P_交互作用= 0.002)。结论：在左主干 CAD 或 3 支血管病变患者中，患者报告的术前身心健康状况与长期死亡率密切相关，并改变了 PCI 与 CABG 的相对治疗效果。与 PCI 相比，身体和心理健康状况最佳的患者 CABG 的 10 年生存率更高。在选择最佳血运重建策略时，评估自我报告的身心健康非常重要。注册：URL：https://www.clinicaltrials.gov；语法 唯一标识符：NCT03417050。网址：https://www.clinicaltrials.gov；语法 唯一标识符：NCT00114972。