Impact of left ventricular ejection fraction on 10-year mortality in the SYNTAX trial.

Autor: Masuda S; Department of Cardiology, University of Galway, Galway, Ireland., Serruys PW; Department of Cardiology, University of Galway, Galway, Ireland; NHLI, Imperial College London, London, United Kingdom. Electronic address: patrick.serruys@nuigalway.ie., Ninomiya K; Department of Cardiology, University of Galway, Galway, Ireland., Kageyama S; Department of Cardiology, University of Galway, Galway, Ireland., Nozomi K; Department of Cardiology, University of Galway, Galway, Ireland., Gao C; Department of Cardiology, Xijing Hospital, Xi'an, China; Department of Cardiology, Radboud University, Nijmegen, the Netherlands., Mack MJ; Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, TX, USA., Holmes DR; Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA., Morice MC; Département of Cardiologie, Hôpital privé Jacques Cartier, Générale de Santé Massy, France., Thuijs DJFM; Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands., Milojevic M; Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands., Davierwala PM; University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany; Department of Surgery, University of Toronto, Toronto, Canada; Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada., Garg S; Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom., Onuma Y; Department of Cardiology, University of Galway, Galway, Ireland.
Jazyk: angličtina
Zdroj: Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2024 Jan; Vol. 58, pp. 7-15. Date of Electronic Publication: 2023 Jun 30.
DOI: 10.1016/j.carrev.2023.06.031
Abstrakt: Backgrounds: The impact of reduced left ventricular ejection fraction (LVEF) on very long-term prognosis following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) has been debated. The aim of this study was to investigate the impact of LVEF at baseline on 10-year mortality in the SYNTAX trial.
Methods: Patients (n = 1800) were categorized into three sub-groups: reduced (rEF ≤ 40 %), mildly reduced (mrEF 41-49 %), and preserved LVEF (pEF ≥ 50 %). The SYNTAX score 2020 (SS-2020) was applied in patients with LVEF<50 % and ≥ 50 %.
Results: Ten-year mortalities were 44.0 %, 31.8 %, and 22.6 % (P < 0.001) in patients with rEF (n = 168), mrEF (n = 179), and pEF (n = 1453). Although no significant differences were observed, the mortality with PCI was higher than with CABG in patients with rEF (52.9 % vs 39.6 %, P = 0.054) and mrEF (36.0 % vs. 28.6 %, P = 0.273), and comparable in pEF (23.9 % vs. 22.2 %, P = 0.275). Calibration and discrimination of the SS-2020 in patients with LVEF<50 % were poor, whilst they were reasonable in those with LVEF≥50 %. The proportion of patients eligible for PCI who had a predicted equipoise in mortality with CABG was estimated to be 57.5 % in patients with LVEF≥50 %. CABG was safer than PCI in 62.2 % of patients with LVEF<50 %.
Conclusions: Reduced LVEF was associated with an increased risk of 10-year mortality in patients revascularized either surgically or percutaneously. Compared to PCI, CABG was safe revascularization in patients with LVEF≤40 %. In patients with LVEF≥50 % individualized 10-year all-cause mortality predicted by SS-2020 was helpful in decision-making whilst the predictivity in patients with LVEF<50 % was poor.
Competing Interests: Declaration of competing interest Dr. Masuda reports a grant from TERUMO corporation outside the submitted work. Dr. Patrick W Serruys reports personal institutional grant from Sahajanand Medical Technologies (SMT), Novartis, Xeltis, Phillips/Volcano, and Meril Life outside the submitted work. All other authors have no conflict of interest to declare.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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