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Published on: March 27, 2018
Major infections after bypass surgery and stenting for multivessel coronary disease in the randomised SYNTAX trial
Massimo Mancone1, Rafael Cavalcante, Rodrigo Modolo
1Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
Aims:
Incidence, associated risk factors and impact on mortality of infections after bypass surgery (CABG) and stenting (PCI) for multivessel coronary disease (MVD) have never been reported in a large randomised trial. The aim of the present study was to evaluate, in patients with MVD, the prevalence of major infections after PCI and CABG and to assess their impact on mortality.
Methods And Results:
The SYNTAX trial randomised 1,800 MVD patients to either CABG or PCI. Patients were followed up to five years. The primary endpoint of this post hoc analysis was the occurrence of major infection. At five years of follow-up, the primary endpoint had occurred in 142 (15.8%) patients in the CABG arm and 44 (4.9%) patients in the PCI arm (≤60 days HR - 7.9, 95% CI: 4.7 to 13.1; p<0.001) (>60 days - HR 0.79, 95% CI: 0.44 to 1.44; p=0.45). Major infections were independently associated with a higher risk of all-cause mortality at five years (adjusted HR 2.6, 95% CI: 1.8 to 3.8, p<0.001).
Conclusions:
CABG is associated with a higher incidence of post-procedure major infections compared to PCI. Major infections are independently associated with all-cause mortality.
Insights
Coronary artery bypass grafting (CABG) leads to more major infections than percutaneous coronary intervention (PCI) in multivessel coronary disease (MVD) patients. These infections increase the risk of death.
Area of Science:
- Cardiology
- Infectious Diseases
- Clinical Trials
Background:
- Multivessel coronary disease (MVD) management involves bypass surgery (CABG) and stenting (PCI).
- Post-procedural infections are a known complication, but large randomized trial data on their incidence and impact after CABG vs. PCI for MVD is limited.
Purpose of the Study:
- To determine the incidence of major infections following CABG and PCI in MVD patients.
- To assess the association between these infections and long-term mortality.
Main Methods:
- A post hoc analysis of the SYNTAX trial involving 1,800 MVD patients randomized to CABG or PCI.
- Five-year follow-up to track the occurrence of major infections and all-cause mortality.
Main Results:
- Major infections occurred in 15.8% of CABG patients versus 4.9% of PCI patients within five years.
- Higher incidence of infection was observed early after CABG (HR 7.9, p<0.001).
- Major infections were independently linked to a 2.6-fold increased risk of all-cause mortality (adjusted HR 2.6, p<0.001).
Conclusions:
- Coronary artery bypass grafting (CABG) is associated with a significantly higher rate of major post-procedure infections compared to percutaneous coronary intervention (PCI).
- Major infections following these procedures are an independent predictor of increased all-cause mortality.
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