Journal Article

Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study

Thuijs Daniel J F M, van Geuns Robert Jan, Head, Stuart J, Morice Marie-Claude, Takahashi, Kuniaki, Curzen Nick, Friedrich-Wilhelm, Mohr, Mack, Michael J, Garg, Scot, Kappetein, Arie Pieter, Piroze, Davierwala, Holmes, David R, Onuma Yoshinobu, Milojevic Milan, Wang, Rutao, Serruys, Patrick W

2021

Overview

BackgroundCoronary bypass artery grafting (CABG) has a higher procedural risk of stroke than percutaneous coronary intervention (PCI), but may offer better long-term survival. The optimal revascularization strategy for patients with prior cerebrovascular disease (CEVD) remains unclear.Methods and resultsThe SYNTAXES study assessed the vital status out to 10 year of patients with three-vessel disease and/or left main coronary artery disease enrolled in the SYNTAX trial. The relative efficacy of PCI vs. CABG in terms of 10 year all-cause death was assessed according to prior CEVD. The primary endpoint was 10 year all-cause death. The status of prior CEVD was available in 1791 (99.5%) patients, of whom 253 patients had prior CEVD. Patients with prior CEVD were older and had more comorbidities (medically treated diabetes, insulin-dependent diabetes, metabolic syndrome, peripheral vascular disease, chronic obstructive pulmonary disease, impaired renal function, and congestive heart failure), compared with those without prior CEVD. Prior CEVD was an independent predictor of 10 year all-cause death (adjusted HR: 1.35; 95% CI: 1.04–1.73; p = 0.021). Patients with prior CEVD had a significantly higher risk of 10 year all-cause death (41.1 vs. 24.1%; HR: 1.92; 95% CI: 1.54–2.40; p < 0.001). The risk of 10 year all-cause death was similar between patients receiving PCI or CABG irrespective of the presence of prior CEVD (p-interaction = 0.624).ConclusionPrior CEVD was associated with a significantly increased risk of 10 year all-cause death which was similar in patients treated with PCI or CABG. These results do not support preferential referral for PCI rather than CABG in patients with prior CEVD.Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.Graphic abstract

• Publisher: Springer Nature B.V
• Subject: Cardiovascular disease / Cerebrovascular disease / Cerebrovascular diseases / Chronic obstructive pulmonary disease / Congestive heart failure / Coronary artery / Coronary artery disease / Death / Diabetes / Diabetes mellitus (insulin dependent) / Heart surgery / Insulin / Lung diseases / Metabolic disorders / Metabolic syndrome / Obstructive lung disease / Renal function / Risk / Survival / Syntax / Vascular diseases