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Impact of preprocedural biological markers on 10-year mortality in the SYNTAXES trial

Hironori Hara1,2, Hideyuki Kawashima1,2, Masafumi Ono1,2

  • 1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|October 20, 2021
PubMed

Insights

Pre-procedure C-reactive protein (CRP), HbA1c, and creatinine clearance (CrCl) predict 10-year mortality after coronary revascularisation. Statin use is crucial for better outcomes, as non-use indicates a worse prognosis.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Research

Background:

  • Creatinine clearance (CrCl) is a known predictor of mortality in complex coronary artery disease.
  • The SYNTAX Extended Survival (SYNTAXES) study investigates long-term outcomes after coronary revascularisation.

Purpose of the Study:

  • To determine the impact of preprocedural biological markers on 10-year mortality following coronary revascularisation.
  • To assess the association of C-reactive protein (CRP), HbA1c, CrCl, and lipid profiles with long-term survival.

Main Methods:

  • Analysis of 10-year vital status follow-up for 1,800 patients from the SYNTAXES study.
  • Evaluation of patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD) undergoing percutaneous or surgical revascularisation.
  • Statistical analysis of preprocedural CRP, HbA1c, CrCl, and lipid markers in relation to all-cause mortality.

Main Results:

  • Elevated CRP (≥2 mg/L), HbA1c (≥6%), and low CrCl (<60 ml/min) were associated with increased 10-year all-cause death.
  • No significant interaction was found between these markers and the type of revascularisation.
  • Preprocedural lipid markers were not significantly associated with mortality, but non-use of statins predicted a worse prognosis.

Conclusions:

  • Preprocedural CRP and HbA1c levels are significant predictors of long-term mortality post-revascularisation, irrespective of the technique used.
  • The effectiveness of statins in mitigating risks associated with lipid biomarkers is highlighted.
  • Non-adherence to statin therapy is a critical factor contributing to poorer long-term prognosis, underscoring the importance of pharmacological management.
Abstract

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