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Ninomiya K, Serruys PW, Garg S, Gao C, Masuda S, Lunardi M, Burzotta F, Morice MC, Colombo A, Mack MJ, Holmes DR, Davierwala PM, Thuijs D, Onuma Y. Impact of bifurcation lesion on 10-year mortality in the SYNTAX trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Percutaneous coronary intervention (PCI) of bifurcation lesions is associated with higher rates of adverse events, and currently it is unclear whether PCI or coronary artery bypass grafting (CABG) is the safer treatment for these patients at very long-term follow up.
Objectives
To investigate the impact of bifurcation lesions on observed all-cause 10-year mortality in the SYNTAX trial.
Methods
In the SYNTAX Extended Survival study, 10-year observed mortality was compared among four groups: (a) presence of ≥1 bifurcation lesion and treatment with PCI (n=649), (b) no bifurcation lesion and treatment with PCI (n=248), (c) presence of ≥1 bifurcation lesion and treatment with CABG (n=651), and (d) no bifurcation lesion and treatment with CABG (n=239).
Results
Compared to patients without bifurcations, those with bifurcation lesion(s) treated with PCI had a significantly higher risk of all-cause death (19.8% vs 30.1%; HR: 1.55, 95% CI: 1.12 to 2.14; p=0.007), whereas following CABG, mortality was similar in patients with or without bifurcation lesion(s) (23.3% vs 23.0%; HR: 0.81, 95% CI: 0.59 to 1.12; p=0.207). (Figure1) There was a significant interaction between bifurcation lesion(s) and treatment arm (p for interaction=0.006).
In PCI patients, at 5-years there was no significant difference in mortality between 1- vs 2-stent techniques, whereas at 10-years, a 2-stent technique was associated with higher mortality (33.3% vs 25.9%; HR: 1.51, 95% CI: 1.06 to 2.14; p=0.021, Figure2).
Conclusions
Bifurcation lesion(s) require special attention from the heart team discussion, considering the higher 10-year all-cause mortality associated with PCI. Careful evaluation of bifurcation lesion complexity may be helpful in decision-making.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The SYNTAX Extended Survival study was supported by the German Foundation of Heart Research (Frankfurt am Main, Germany). The SYNTAX trial, during 0-5 years follow-up, was funded by Boston Scientific Corporation (Marlborough, MA, USA). Both sponsors had no role in the study design, data collection, data analyses, and interpretation of the study data, nor were involved in the decision to publish the final manuscript. The principal investigators and authors had complete scientific freedom.
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Affiliation(s)
- K Ninomiya
- National University of Ireland , Galway , Ireland
| | - P W Serruys
- National University of Ireland , Galway , Ireland
| | - S Garg
- Royal Blackburn Hospital , Blackburn , United Kingdom
| | - C Gao
- National University of Ireland , Galway , Ireland
| | - S Masuda
- National University of Ireland , Galway , Ireland
| | - M Lunardi
- National University of Ireland , Galway , Ireland
| | - F Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - M C Morice
- Jacques Cartier Private Hospital , Massy , France
| | - A Colombo
- Humanitas Research Hospital , Milan , Italy
| | - M J Mack
- Baylor University Medical Center , Dallas , United States of America
| | - D R Holmes
- Mayo Clinic , Rochester , United States of America
| | | | - D Thuijs
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Y Onuma
- National University of Ireland , Galway , Ireland
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Davierwala PM, Leontyev S, Gunter K, Bakhtiary F, Borger M, Misfeld M, Mohr F, Davierwala P. 297 * EARLY AND LATE OUTCOMES OF COMPLEX AORTIC ROOT SURGERY IN PATIENTS WITH AORTIC ROOT ABSCESSES. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Head SJ, Davierwala PM, Serruys PW, Redwood SR, Colombo A, Mack MJ, Morice MC, Holmes DR, Feldman TE, Stahle E, Underwood P, Dawkins KD, Kappetein AP, Mohr FW. Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial. Eur Heart J 2014; 35:2821-30. [DOI: 10.1093/eurheartj/ehu213] [Citation(s) in RCA: 246] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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