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Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical

Rutao Wang1,2,3, Mattia Lunardi4,5, Hironori Hara2,6

  • 1Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|May 7, 2023
PubMed

Insights

Repeat revascularization within 5 years did not impact overall 10-year mortality for patients with complex coronary artery disease. However, those needing repeat procedures after initial PCI faced higher mortality than after CABG.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Trials

Background:

  • The SYNTAX trial indicated repeat revascularization (RR) negatively impacts 5-year outcomes in 3-vessel disease (3VD) and/or left main coronary artery disease (LMCAD).
  • The SYNTAXES study aimed to assess the 10-year mortality impact of RR within 5 years in these patients.

Purpose of the Study:

  • To evaluate the effect of repeat revascularization within 5 years on 10-year all-cause mortality.
  • To compare outcomes between Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) in patients requiring repeat procedures.

Main Methods:

  • The SYNTAXES study analyzed 10-year vital status data from patients with 3VD and/or LMCAD.
  • Patients were stratified based on whether they underwent repeat revascularization within 5 years and their initial randomized treatment (PCI vs. CABG).
  • Statistical analysis assessed the association between repeat revascularization and 10-year mortality.

Main Results:

  • 18.3% of patients underwent repeat revascularization within 5 years; it was more frequent after initial PCI (25.9%) than CABG (13.7%).
  • Overall 10-year mortality was similar between patients with and without repeat revascularization (28.2% vs. 26.1%).
  • Among patients requiring repeat procedures, initial PCI was associated with higher 10-year mortality (33.5%) compared to initial CABG (17.6%, adjusted HR: 2.09).

Conclusions:

  • Repeat revascularization within 5 years did not significantly impact overall 10-year mortality in the studied population.
  • For patients requiring repeat procedures, initial PCI was linked to a higher risk of 10-year mortality compared to initial CABG.
  • Further investigation in larger cohorts is warranted to confirm these exploratory findings.
Abstract

Keywords:
All-cause deathCoronary artery bypass graftingPercutaneous coronary interventionRepeat revascularizationSYNTAX

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