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10-Year All-Cause Mortality Following Percutaneous or Surgical Revascularization in Patients With Heavy Calcification

Hideyuki Kawashima1, Patrick W Serruys2, Hironori Hara1

  • 1Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

JACC. Cardiovascular Interventions
|January 2, 2022
PubMed

Insights

Heavily calcified lesions (HCLs) independently predict 10-year mortality after coronary revascularization. The choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) did not significantly impact outcomes in patients with HCLs.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Limited long-term outcome data exist for patients with heavily calcified lesions (HCLs) undergoing revascularization.
  • Understanding the impact of HCLs on mortality after percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) is crucial for treatment decisions.

Purpose of the Study:

  • To assess 10-year all-cause mortality in patients with HCLs treated with PCI or CABG.
  • To determine if HCLs are an independent predictor of long-term mortality.
  • To investigate the interaction between HCLs and revascularization strategy on mortality.

Main Methods:

  • A substudy of the SYNTAX trial, including 1,800 patients with 3-vessel and/or left main disease randomized to PCI or CABG.
  • Patients were analyzed based on the presence or absence of HCLs (lesions with >50% diameter stenosis).
  • 10-year all-cause mortality was compared between groups, with adjustments for baseline characteristics and interaction analysis.

Main Results:

  • Patients with at least one HCL had significantly higher 10-year mortality (36.4%) compared to those without HCLs (22.3%).
  • HCLs remained an independent predictor of 10-year mortality after adjustment (HR: 1.36).
  • While PCI showed higher mortality than CABG in patients without HCLs, no significant difference was observed in patients with HCLs.

Conclusions:

  • The presence of HCLs is an independent predictor of 10-year mortality following coronary revascularization.
  • Prognosis appears similar between PCI and CABG in patients with HCLs.
  • Further evaluation is needed to determine if HCLs warrant special consideration beyond their current role in anatomical scoring for revascularization decisions.
Abstract

Keywords:
SYNTAXcalcificationcoronary artery bypass graftinglong-term mortalitypercutaneous coronary intervention

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