Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization.

Autor: Wang R; Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.; Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland.; Department of Cardiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands., Lunardi M; The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland.; Department of Cardiology, University Hospital of Verona, Verona, Italy., Hara H; Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland.; Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., Gao C; Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.; Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland.; Department of Cardiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands., Ono M; Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland.; Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., Davierwala PM; Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada., Holmes DR; Mayo Clinic, Rochester, MN, USA., Mohr FW; Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany., Curzen N; Faculty of Medicine, University of Southampton and Cardiology Department, University Hospital Southampton, Southampton, UK., Burzotta F; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy., van Geuns RJ; Department of Cardiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands., Kappetein AP; Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands., Head SJ; Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands., Thuijs DJFM; Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands., Tao L; Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China., Garg S; East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK., Onuma Y; Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland., Wijns W; The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland., Serruys PW; Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland. patrick.w.j.c.serruys@gmail.com.; NHLI, Imperial College London, London, UK. patrick.w.j.c.serruys@gmail.com.
Jazyk: angličtina
Zdroj: Clinical research in cardiology : official journal of the German Cardiac Society [Clin Res Cardiol] 2023 Sep; Vol. 112 (9), pp. 1302-1311. Date of Electronic Publication: 2023 May 08.
DOI: 10.1007/s00392-023-02211-6
Abstrakt: Background: The SYNTAX trial demonstrated negative impact of repeat revascularization (RR) on 5-year outcomes following PCI/CABG in patients with three-vessel(3VD) and/or left main coronary artery disease(LMCAD). We aimed to investigate the impact of RR within 5 years, on 10-year mortality in patients with 3VD and/or LMCAD after PCI/CABG.
Methods: The SYNTAXES study evaluated the vital status out to 10 years of patients with 3VD and/or LMCAD. Patients were stratified by RR within 5 years and randomized treatment. The association between RR within 5 years and 10-year mortality was assessed.
Results: A total of 330 out of 1800 patients (18.3%) underwent RR within 5 years. RR occurred more frequently after initial PCI than after initial CABG (25.9% vs. 13.7%, p < 0.001). Overall, 10-year mortality was comparable between patients undergoing RR and those not (28.2% vs. 26.1%, adjusted HR: 1.17, 95%CI 0.93-1.48, p = 0.187). In the PCI arm, RR was associated with a trend toward higher 10-year mortality (adjusted HR: 1.29, 95%CI 0.97-1.72, p = 0.075), while in the CABG arm, the trend was opposite (adjusted HR: 0.74, 95%CI 0.46-1.20, p = 0.219). Among patients requiring RR, those who underwent PCI as initial revascularization had a higher risk of 10-year mortality compared to initial CABG (33.5% vs. 17.6%, adjusted HR: 2.09, 95%CI 1.21-3.61, p = 0.008).
Conclusion: In the SYNTAXES study, RR within 5 years had no impact on 10-year all-cause death in the population overall. Among patients requiring any repeat procedures, 10-year mortality was higher after initial treatment with PCI than after CABG. These exploratory findings should be investigated with larger populations in future studies.
Trial Registration: URL: https://www.
Clinicaltrials: gov ; SYNTAXES Unique identifier: NCT03417050. URL: https://www.
Clinicaltrials: gov ; SYNTAX Unique identifier: NCT00114972.
(© 2023. The Author(s).)
Databáze: MEDLINE
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