AI Article Synopsis
- The study aimed to evaluate how existing cardiovascular disease (CVD) affects the risk of death over 10 years after coronary revascularization in patients with complex coronary artery disease (CAD).
- It found that patients with established CVD had a significantly higher risk of 10-year all-cause death compared to those without CVD, and the risk was especially elevated for those with CVD affecting multiple heart territories.
- The results suggest that while patients with CVD may face some increased risks, they should not be automatically excluded from undergoing necessary treatments like angiography or revascularization, as the long-term outcomes remain acceptable.
Article Abstract
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 = 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.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8484091 | PMC |
| http://dx.doi.org/10.1007/s00392-021-01922-y | DOI Listing |
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