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Mortality 10 Years After Percutaneous or Surgical Revascularization in Patients With Total Coronary Artery Occlusions
Hideyuki Kawashima1, Kuniaki Takahashi2, Masafumi Ono3
1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland. Electronic address: https://twitter.com/HideyukiKawash2.
Insights
Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) outcomes for total occlusions (TOs) were analyzed. Recanalization or revascularization status did not impact 10-year mortality in patients with complex coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Long-term clinical benefits of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for total occlusions (TOs) in complex coronary artery disease remain unclear.
- Understanding the impact of revascularization strategies on mortality is crucial for patient management.
Purpose of the Study:
- To assess the 10-year all-cause mortality in patients with TOs undergoing PCI or CABG.
- To evaluate the effect of TO recanalization or revascularization status on long-term mortality.
Main Methods:
- Subanalysis of patients with at least one TO from the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study.
- 10-year all-cause mortality data from the SYNTAX trial, extending beyond the original 5-year follow-up.
- Patients with TOs were stratified based on recanalization or revascularization status.
Main Results:
- Among 460 patients with TOs, recanalization or revascularization status was not associated with 10-year all-cause mortality, regardless of treatment (PCI or CABG).
- PCI arm: 29.9% vs. 29.4% mortality; CABG arm: 28.0% vs. 21.4% mortality.
- No significant impact on mortality was observed even when TOs involved the left main and/or left anterior descending artery.
Conclusions:
- Recanalization or revascularization of total occlusions does not significantly affect 10-year mortality, irrespective of treatment strategy or TO location.
- Findings may support current practices in high-volume centers for chronic TO PCI, focusing on symptom management and myocardial viability.
- The study provides long-term insights into the management of complex coronary artery disease with total occlusions.
Background:
The long-term clinical benefit after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with total occlusions (TOs) and complex coronary artery disease has not yet been clarified.
Objectives:
The objective of this analysis was to assess 10-year all-cause mortality in patients with TOs undergoing PCI or CABG.
Methods:
This is a subanalysis of patients with at least 1 TO in the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which investigated 10-year all-cause mortality in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial, beyond its original 5-year follow-up. Patients with TOs were further stratified according to the status of TO recanalization or revascularization.
Results:
Of 1,800 randomized patients to the PCI or CABG arm, 460 patients had at least 1 lesion of TO. In patients with TOs, the status of TO recanalization or revascularization was not associated with 10-year all-cause mortality, irrespective of the assigned treatment (PCI arm: 29.9% vs. 29.4%; adjusted hazard ratio [HR]: 0.992; 95% confidence interval [CI]: 0.474 to 2.075; p = 0.982; and CABG arm: 28.0% vs. 21.4%; adjusted HR: 0.656; 95% CI: 0.281 to 1.533; p = 0.330). When TOs existed in left main and/or left anterior descending artery, the status of TO recanalization or revascularization did not have an impact on the mortality (34.5% vs. 26.9%; adjusted HR: 0.896; 95% CI: 0.314 to 2.555; p = 0.837).
Conclusions:
At 10-year follow-up, the status of TO recanalization or revascularization did not affect mortality, irrespective of the assigned treatment and location of TOs. The present study might support contemporary practice among high-volume chronic TO-PCI centers where recanalization is primarily offered to patients for the management of angina refractory to medical therapy when myocardial viability is confirmed. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).
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