Mortality after multivessel revascularisation involving the proximal left anterior descending artery

Masafumi Ono, Hironori Hara, Chao Gao, Hideyuki Kawashima, Rutao Wang, Neil O'Leary, Joanna J Wykrzykowska, Jan J Piek, Michael J Mack, David Holmes, Marie-Claude Morice, Stuart Head, Arie Pieter Kappetein, Thilo Noack, Piroze M Davierwala, Friedrich W Mohr, Scot Garg, Yoshinobu Onuma, Patrick W Serruys, SYNTAX Extended Survival InvestigatorsMatthias Corbascio (Medlem af forfattergruppering)

Abstract

OBJECTIVE: We sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD).

METHODS: This post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed.

RESULTS: Among 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, pinteraction=0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; pinteraction=0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality.

CONCLUSIONS: Among patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG.

TRIAL REGISTRATION NUMBER: SYNTAXES: NCT03417050; SYNTAX: NCT00114972.

OriginalsprogEngelsk
TidsskriftHeart (British Cardiac Society)
Vol/bind108
Udgave nummer22
Sider (fra-til)1784-1791
Antal sider8
ISSN1355-6037
DOI
StatusUdgivet - 28 okt. 2022

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