Assessing Long-Term All-Cause Mortality After PCI vs CABG

The risk for 10-year all-cause mortality was found to be comparable after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) surgery in patients with prior cerebrovascular disease (CEVD), according to a study published in Clinical Research in Cardiology.

This was an analysis of the TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries (SYNTAX) and SYNTAX Extended Survival studies (ClinicalTrials.gov Identifiers: NCT00114972 and NCT03417050, respectively), conducted to evaluate the 10-year vital status of participants with 3-vessel disease and/or left main coronary artery disease who underwent PCI or CABG. In this cohort, 253 and 1538 patients had and did not have prior CEVD, respectively.

Among participants with prior CEVD, 119 underwent PCI and 134 underwent CABG. In patients without prior CEVD, 782 underwent PCI and 756 had CABG. Patients with vs without prior CEVD were significantly older (mean age, 68.2±8.7 vs 64.6±9.8 years, respectively; P <.001) and had greater rates of comorbidities (medically treated diabetes: 32.4% vs 23.9%, respectively; P =.004; insulin-dependent diabetes: 15% vs 9.2%, respectively; P =.005; metabolic syndrome: 43.1% vs 35.4%, respectively; P =.041; peripheral vascular disease: 24.5% vs 7.5%, respectively; P <.001; chronic obstructive pulmonary disease: 14.6% vs 7.5%, respectively; P <.001; impaired renal function: 32.6% vs 17.2%, respectively; P <.001; and congestive heart failure: 7.3% vs 4.3%, respectively; P =.036).

The study’s median follow-up period was 11.2 years. Median follow-up duration in survivors was 11.9 years. Prior CEVD was found to be an independent predictor of 10-year all-cause mortality (adjusted hazard ratio [HR], 1.35; 95% CI, 1.04–1.73; P =.021) and to be associated with a higher risk for 10-year all-cause mortality compared with absence of prior CEVD (41.1% vs 24.1%, respectively; HR, 1.92; 95% CI, 1.54–2.40; P <.001). Participants who underwent PCI vs CABG had comparable risk for 10-year all-cause death, irrespective of prior CEVD (P =.624).

Limitations of this study include its post-hoc nature, and a relatively small sample size in the group with prior CEVD.

 “The current findings from the SYNTAXES study do not support preferential referral for PCI rather than CABG in this population on the basis of a history of prior CEVD,” concluded the study authors. “[D]ecision making needs to include assessment of both short- and long-terms risks while discussing strategies amongst care providers and with patients.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Wang R, Takahashi K, Garg S, et al. Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study. Published online January 30, 2021. Clin Res Cardiol. doi:10.1007/s00392-020-01802-x