Related Experiment Video
Updated: Oct 20, 2025
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Ten-Year All-Cause Mortality Following Staged Percutaneous Revascularization in Patients With Complex Coronary Artery
Hideyuki Kawashima1, Masafumi Ono1, Hironori Hara1
1Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Insights
Staged percutaneous coronary intervention (SPCI) in complex coronary artery disease patients with three-vessel disease or left main disease is linked to higher 10-year mortality. Coronary artery bypass grafting (CABG) may be preferable for staged procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Assessing the very long-term (10-year) impact of staged percutaneous coronary intervention (SPCI) in complex coronary artery disease (CAD).
- Evaluating all-cause mortality in patients with three-vessel disease (3VD) and/or left main (LM) disease undergoing SPCI.
- Utilizing a sub-analysis of the SYNTAXES study, extending the SYNTAX trial's follow-up beyond 5 years.
Discussion:
- SPCI was associated with significantly higher 10-year all-cause mortality compared to both non-staged PCI and coronary artery bypass grafting (CABG).
- The increased mortality risk with SPCI was observed in both 3VD and LM disease subgroups.
- This suggests that the benefits of single-session PCI or CABG may outweigh staged approaches in complex CAD.
Key Insights:
- Patients undergoing SPCI demonstrated a 40.0% 10-year mortality rate, versus 26.6% for those not having SPCI and 24.5% for those undergoing CABG.
- For 3VD patients, SPCI mortality was 37.4% compared to 27.1% for non-SPCI.
- For LM disease patients, SPCI mortality was 51.8% compared to 25.9% for non-SPCI.
Outlook:
- Further research may explore patient-specific factors influencing outcomes after SPCI versus single-session PCI or CABG.
- Clinical guidelines may need to be revisited regarding the optimal revascularization strategy for complex CAD, particularly when staging is considered.
- Investigating the economic implications alongside clinical outcomes for staged versus non-staged interventions in complex CAD.
Background:
Medical and/or economic reasons sometimes necessitate the staging of percutaneous coronary intervention (SPCI) procedures in patients with complex coronary artery disease; however, the impact of this on very long-term outcomes is unknown. The aim of the present study is to assess 10-year all-cause mortality in patients with the three-vessel disease (3VD) and/or left main disease (LM) undergoing SPCI.
Methods:
This is a sub-analysis of patients undergoing SPCI in the SYNTAXES study, which investigated 10-year all-cause mortality in patients with 3VD and/or LM in the randomized SYNTAX trial, beyond its original 5-year follow-up. An SPCI was allowed within 72 h or, if renal insufficiency or contrast-induced nephropathy occurred, within 14 days of the index procedure. Mortality was compared between patients having SPCI versus those not having SPCI or undergoing CABG. PCI patients were further stratified according to 3VD or LM.
Results:
In the SYNTAX PCI population (overall: n = 903, 3VD: n = 546, LM: n = 357), 125 (13.8%) patients underwent SPCI. Patients with SPCI had a higher 10-year mortality compared to those who didn't (40.0% vs 26.6%; hazard ratio [HR] 1.69; 95% confidence interval [CI] 1.23-2.32; p < 0.01) and those having CABG(40.0% vs 24.5%; HR 1.85; 95%CI 1.35-2.53; p < 0.01). Patients having SPCI with 3VD (n = 103) or LM (n = 22) had higher mortality than respective patients not having SPCI (3VD: 37.4% vs 27.1%; HR 1.52; 95%CI 1.05-2.21; p = 0.03 and LM: 51.8% vs 25.9%; HR 2.39; 95%CI 1.27-4.47; p = 0.01).
Conclusions:
At 10-year follow-up, SPCI was associated with higher mortality than single-session PCI, so that CABG may be preferable if a staged procedure is anticipated.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
04:30A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction