Related Experiment Video
Updated: Mar 27, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Causes of Death Following PCI Versus CABG in Complex CAD: 5-Year Follow-Up of SYNTAX
Milan Milojevic1, Stuart J Head1, Catalina A Parasca1
1Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Insights
Coronary artery bypass grafting (CABG) significantly reduced myocardial infarction (MI)-related deaths compared to percutaneous coronary intervention (PCI) over 5 years. These findings highlight the need to target MI reduction post-PCI and emphasize ongoing secondary prevention.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Trials
Background:
- Limited data exist on specific causes of death in randomized trials comparing CABG and PCI.
- Understanding these differences is crucial for guiding treatment decisions in complex coronary artery disease.
Purpose of the Study:
- To investigate specific causes of death and their predictors following revascularization for complex coronary disease.
- To compare mortality outcomes between CABG and PCI in a 5-year follow-up period.
Main Methods:
- An independent Clinical Events Committee blinded to treatment classified causes of death (cardiovascular, noncardiovascular, undetermined).
- Cardiac deaths were further subclassified into sudden cardiac, MI-related, and other cardiac causes.
- Data were analyzed from a randomized trial cohort with 5-year follow-up.
Main Results:
- CABG showed a significantly lower rate of MI-related death (0.4% vs. 4.1%, p <0.0001) compared to PCI.
- Cardiovascular and cardiac death rates were significantly lower after CABG than PCI (5.8% vs. 9.6% and 5.3% vs. 9.0%, respectively).
- PCI was an independent predictor of cardiac death (HR: 1.55; 95% CI: 1.09-2.33; p=0.045), particularly in patients with diabetes, 3-vessel disease, or high SYNTAX scores.
Conclusions:
- CABG is associated with a significantly reduced rate of MI-related death compared to PCI over 5 years.
- MI-related death was the leading cause of death after PCI, suggesting a need for targeted interventions.
- Secondary preventive medications remain critical for reducing post-revascularization events.
Background:
There are no data available on specific causes of death from randomized trials that have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI).
Objectives:
The purpose of this study was to investigate specific causes of death, and its predictors, after revascularization for complex coronary disease in patients.
Methods:
An independent Clinical Events Committee consisting of expert physicians who were blinded to the study treatment subclassified causes of death as cardiovascular (cardiac and vascular), noncardiovascular, or undetermined according to the trial protocol. Cardiac deaths were classified as sudden cardiac, related to myocardial infarction (MI), and other cardiac deaths.
Results:
In the randomized cohort, there were 97 deaths after CABG and 123 deaths after PCI during a 5-year follow-up. After CABG, 49.4% of deaths were cardiovascular, with the greatest cause being heart failure, arrhythmia, or other causes (24.6%), whereas after PCI, the majority of deaths were cardiovascular (67.5%) and as a result of MI (29.3%). The cumulative incidence rates of all-cause death were not significantly different between CABG and PCI (11.4% vs. 13.9%, respectively; p = 0.10), whereas there were significant differences in terms of cardiovascular (5.8% vs. 9.6%, respectively; p = 0.008) and cardiac death (5.3% vs. 9.0%, respectively; p = 0.003), which were caused primarily by a reduction in MI-related death with CABG compared with PCI (0.4% vs. 4.1%, respectively; p <0.0001). Treatment with PCI versus CABG was an independent predictor of cardiac death (hazard ratio: 1.55; 95% confidence interval: 1.09 to 2.33; p = 0.045). The difference in MI-related death was seen largely in patients with diabetes, 3-vessel disease, or high SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries) trial scores.
Conclusions:
During a 5-year follow-up, CABG in comparison with PCI was associated with a significantly reduced rate of MI-related death, which was the leading cause of death after PCI. Treatments following PCI should target reducing post-revascularization spontaneous MI. Furthermore, secondary preventive medication remains essential in reducing events post-revascularization. (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Coronary Artery Disease III: Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:28Cardiac Catheterization I: Pre-Procedure Overview