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Published on: December 11, 2017
Impact of periprocedural major adverse events on 10-year mortality after revascularisation
Nozomi Kotoku1, Patrick W Serruys1, Kai Ninomiya1
1Department of Cardiology, University of Galway, Galway, Ireland.
Insights
Non-fatal major adverse events after coronary revascularization are more common with bypass surgery but have similar long-term impacts. Optimal medical therapy may improve survival for these patients, especially in the first year.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- The long-term prognostic significance of periprocedural major adverse events (PMAE) after revascularization for complex coronary artery disease (CAD) remains unclear.
- Establishing the prognostic impact of these events is crucial for guiding treatment decisions and patient management.
Purpose of the Study:
- To assess the 10-year mortality impact of non-fatal PMAE following percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG).
- To evaluate if PMAE influence mortality predictions from the SYNTAX score II 2020 (SSII-2020).
- To determine if optimal medical therapy (OMT) improves prognosis in patients experiencing non-fatal PMAE.
Main Methods:
- Investigated the association between 10-year mortality and non-fatal PMAE within 30 days of PCI or CABG.
- Included patients with three-vessel disease and/or left main disease from the SYNTAXES study.
- Analyzed the impact of PMAE on SSII-2020 mortality predictions and the role of OMT.
Main Results:
- Non-fatal PMAE occurred less frequently after PCI (11.2%) compared to CABG (28.2%).
- Non-fatal PMAE independently predicted all-cause mortality in the first year post-procedure, but not at 5 or 10 years.
- PMAE significantly altered SSII-2020 10-year mortality predictions, and OMT may offer survival benefits, particularly within the first year.
Conclusions:
- While non-fatal PMAE are more frequent after CABG, their prognostic impact on 10-year mortality is similar to PCI, diminishing after the first year.
- Patients experiencing non-fatal PMAE may benefit from closer follow-up and intensified preventive strategies in the initial year post-procedure.
Background:
The long-term prognostic impact of a composite of periprocedural major adverse events (PMAE) following revascularisation for patients with complex coronary artery disease (CAD) has not yet been established.
Aims:
This study aimed to assess the impact on 10-year mortality of non-fatal PMAE following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Other objectives were to evaluate 1) whether PMAE affect mortality predicted by the SYNTAX score II 2020 (SSII-2020) and 2) whether optimal medical therapy (OMT) positively affects the prognosis of patients with non-fatal PMAE.
Methods:
The association between 10-year mortality and non-fatal PMAE occurring within 30 days of PCI or CABG in patients with three-vessel disease and/or left main disease enrolled in the SYNTAXES study was investigated.
Results:
The main findings are that non-fatal PMAE occurred less frequently following PCI than CABG (11.2% vs 28.2%; p<0.001) and that non-fatal PMAE were an independent predictor of all-cause mortality in the first year post-procedure, but not at 5 or 10 years, in both treatment modalities. PMAE substantially alter the individual predictions of 10-year mortality by the SSII-2020. In patients with non-fatal PMAE, OMT may provide survival benefits during the first year post-procedure as well as in the long term.
Conclusions:
In patients with complex CAD, non-fatal PMAE were more common following CABG than PCI, but their prognostic impact was similar, being significant in the first year and then diminishing out to 10 years. Patients with non-fatal PMAE may therefore require more careful follow-up and additional preventive treatment in the first year post-procedure.
