Impact of established cardiovascular disease on 10-year death after coronary revascularization for complex coronary artery disease

Rutao Wang,Chao Gao,Robert-Jan Van Geuns,Masafumi Ono,Piroze M Davierwala,William Wijns,Hironori Hara,Arie Pieter Kappetein,Patrick W Serruys,Ling Tao,Hideyuki Kawashima,Scot Garg,David R Holmes,Yoshinobu Onuma,Marie-Claude Morice

doi:10.1007/s00392-021-01922-y

Abstract

AimsTo 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).MethodsThe 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.ResultsEstablished 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.ConclusionsThe 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 registrationSYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.Graphic abstract

Highlights

Atherothrombosis is a systemic disease, usually involving more than one arterial bed, which has been termed poly-vascular disease [1, 2]
A total of 1800 patients were randomised in the SYNTAX trial, of which 29 had at least one missing piece of data on the status of co-existing established cardiovascular disease (CVD)
We assessed the impact of established CVD on 10-year all-cause death and evaluated the treatment effect of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with 3VD and/or left main coronary artery disease (LMCAD)

Summary

Introduction

Atherothrombosis is a systemic disease, usually involving more than one arterial bed, which has been termed poly-vascular disease [1, 2]. To date, most available data are derived from cardiovascular prevention studies [7], and only limited data exist on outcomes following revascularization of patients with CAD and co-existing poly-vascular disease [8, 9]. These studies show that these vascular patients were less likely to undergoing invasive revascularization [10], and following percutaneous coronary intervention (PCI), they have a higher risk of short- and mid-term mortality [8, 9, 11, 12]. The optimal revascularization strategy for these patients has not been fully investigated

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