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

SYNTAX Extended Survival Investigators

doi:10.1016/j.jcin.2021.10.026

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

SYNTAX Extended Survival Investigators

Medicine

University of Galway
University of Amsterdam
National Heart and Lung Institute
Radboud University
Royal Blackburn Hospital
Baylor Scott & White Health
Mayo Clinic
Générale de Santé Massy
Erasmus MC
Dedinje Cardiovascular Institute
Heart Centre Leipzig
Peter Munk Cardiac Centre
University of Toronto

Research output: Contribution to a Journal (Peer & Non Peer) › Article › peer-review

67 Citations (Scopus)

Abstract

Objectives: The aim of this study was to assess 10-year all-cause mortality in patients with heavily calcified lesions (HCLs) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Background: Limited data are available on very long term outcomes in patients with HCLs according to the mode of revascularization. Methods: This substudy of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study assessed 10-year all-cause mortality according to the presence of HCLs within lesions with >50% diameter stenosis and identified during the calculation of the anatomical SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score among 1,800 patients with the 3-vessel disease and/or left main disease randomized to PCI or CABG in the SYNTAX trial. Patients with HCLs were further stratified according to disease type (3-vessel disease or left main disease) and assigned treatment (PCI or CABG). Results: The 532 patients with ≥1 HCL had a higher crude mortality rate at 10 years than those without (36.4% vs 22.3%; HR: 1.79; 95% CI: 1.49-2.16; P < 0.001). After adjustment, an HCL remained an independent predictor of 10-year mortality (HR: 1.36; 95% CI: 1.09-1.69; P = 0.006). There was a significant interaction in mortality between treatment effect (PCI and CABG) and the presence or absence of HCLs (P_interaction = 0.005). In patients without HCLs, mortality was significantly higher after PCI than after CABG (26.0% vs 18.8%; HR: 1.44; 95% CI: 0.97-1.41; P = 0.003), whereas in those with HCLs, there was no significant difference (34.0% vs 39.0%; HR: 0.85; 95% CI: 0.64-1.13; P = 0.264). Conclusions: At 10 years, the presence of an HCL was an independent predictor of mortality, with a similar prognosis following PCI or CABG. Whether HCLs require special consideration when deciding the mode of revascularization beyond their current contribution to the anatomical SYNTAX score deserves further evaluation.

Original language	English
Pages (from-to)	193-204
Number of pages	12
Journal	JACC: Cardiovascular Interventions
Volume	15
Issue number	2
DOIs	https://doi.org/10.1016/j.jcin.2021.10.026
Publication status	Published - 24 Jan 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

calcification
coronary artery bypass grafting
long-term mortality
percutaneous coronary intervention
SYNTAX

Access to Document

10.1016/j.jcin.2021.10.026

Cite this

@article{43f2e20a7c2b493f8f64736ab8ae04a6,

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

abstract = "Objectives: The aim of this study was to assess 10-year all-cause mortality in patients with heavily calcified lesions (HCLs) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Background: Limited data are available on very long term outcomes in patients with HCLs according to the mode of revascularization. Methods: This substudy of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study assessed 10-year all-cause mortality according to the presence of HCLs within lesions with >50\% diameter stenosis and identified during the calculation of the anatomical SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score among 1,800 patients with the 3-vessel disease and/or left main disease randomized to PCI or CABG in the SYNTAX trial. Patients with HCLs were further stratified according to disease type (3-vessel disease or left main disease) and assigned treatment (PCI or CABG). Results: The 532 patients with ≥1 HCL had a higher crude mortality rate at 10 years than those without (36.4\% vs 22.3\%; HR: 1.79; 95\% CI: 1.49-2.16; P < 0.001). After adjustment, an HCL remained an independent predictor of 10-year mortality (HR: 1.36; 95\% CI: 1.09-1.69; P = 0.006). There was a significant interaction in mortality between treatment effect (PCI and CABG) and the presence or absence of HCLs (Pinteraction = 0.005). In patients without HCLs, mortality was significantly higher after PCI than after CABG (26.0\% vs 18.8\%; HR: 1.44; 95\% CI: 0.97-1.41; P = 0.003), whereas in those with HCLs, there was no significant difference (34.0\% vs 39.0\%; HR: 0.85; 95\% CI: 0.64-1.13; P = 0.264). Conclusions: At 10 years, the presence of an HCL was an independent predictor of mortality, with a similar prognosis following PCI or CABG. Whether HCLs require special consideration when deciding the mode of revascularization beyond their current contribution to the anatomical SYNTAX score deserves further evaluation.",

keywords = "calcification, coronary artery bypass grafting, long-term mortality, percutaneous coronary intervention, SYNTAX",

author = "\{SYNTAX Extended Survival Investigators\} and Hideyuki Kawashima and Serruys, \{Patrick W.\} and Hironori Hara and Masafumi Ono and Chao Gao and Rutao Wang and Scot Garg and Faisal Sharif and \{de Winter\}, \{Robbert J.\} and Mack, \{Michael J.\} and Holmes, \{David R.\} and Morice, \{Marie Claude\} and Kappetein, \{Arie Pieter\} and Thuijs, \{Daniel J.F.M.\} and Milan Milojevic and Thilo Noack and Mohr, \{Friedrich Wilhelm\} and Davierwala, \{Piroze M.\} and Yoshinobu Onuma",

note = "Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",

year = "2022",

month = jan,

day = "24",

doi = "10.1016/j.jcin.2021.10.026",

language = "English",

volume = "15",

pages = "193--204",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "2",

}

TY - JOUR

T1 - 10-Year All-Cause Mortality Following Percutaneous or Surgical Revascularization in Patients With Heavy Calcification

AU - SYNTAX Extended Survival Investigators

AU - Kawashima, Hideyuki

AU - Serruys, Patrick W.

AU - Hara, Hironori

AU - Ono, Masafumi

AU - Gao, Chao

AU - Wang, Rutao

AU - Garg, Scot

AU - Sharif, Faisal

AU - de Winter, Robbert J.

AU - Mack, Michael J.

AU - Holmes, David R.

AU - Morice, Marie Claude

AU - Kappetein, Arie Pieter

AU - Thuijs, Daniel J.F.M.

AU - Milojevic, Milan

AU - Noack, Thilo

AU - Mohr, Friedrich Wilhelm

AU - Davierwala, Piroze M.

AU - Onuma, Yoshinobu

PY - 2022/1/24

Y1 - 2022/1/24

N2 - Objectives: The aim of this study was to assess 10-year all-cause mortality in patients with heavily calcified lesions (HCLs) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Background: Limited data are available on very long term outcomes in patients with HCLs according to the mode of revascularization. Methods: This substudy of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study assessed 10-year all-cause mortality according to the presence of HCLs within lesions with >50% diameter stenosis and identified during the calculation of the anatomical SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score among 1,800 patients with the 3-vessel disease and/or left main disease randomized to PCI or CABG in the SYNTAX trial. Patients with HCLs were further stratified according to disease type (3-vessel disease or left main disease) and assigned treatment (PCI or CABG). Results: The 532 patients with ≥1 HCL had a higher crude mortality rate at 10 years than those without (36.4% vs 22.3%; HR: 1.79; 95% CI: 1.49-2.16; P < 0.001). After adjustment, an HCL remained an independent predictor of 10-year mortality (HR: 1.36; 95% CI: 1.09-1.69; P = 0.006). There was a significant interaction in mortality between treatment effect (PCI and CABG) and the presence or absence of HCLs (Pinteraction = 0.005). In patients without HCLs, mortality was significantly higher after PCI than after CABG (26.0% vs 18.8%; HR: 1.44; 95% CI: 0.97-1.41; P = 0.003), whereas in those with HCLs, there was no significant difference (34.0% vs 39.0%; HR: 0.85; 95% CI: 0.64-1.13; P = 0.264). Conclusions: At 10 years, the presence of an HCL was an independent predictor of mortality, with a similar prognosis following PCI or CABG. Whether HCLs require special consideration when deciding the mode of revascularization beyond their current contribution to the anatomical SYNTAX score deserves further evaluation.

AB - Objectives: The aim of this study was to assess 10-year all-cause mortality in patients with heavily calcified lesions (HCLs) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Background: Limited data are available on very long term outcomes in patients with HCLs according to the mode of revascularization. Methods: This substudy of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study assessed 10-year all-cause mortality according to the presence of HCLs within lesions with >50% diameter stenosis and identified during the calculation of the anatomical SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score among 1,800 patients with the 3-vessel disease and/or left main disease randomized to PCI or CABG in the SYNTAX trial. Patients with HCLs were further stratified according to disease type (3-vessel disease or left main disease) and assigned treatment (PCI or CABG). Results: The 532 patients with ≥1 HCL had a higher crude mortality rate at 10 years than those without (36.4% vs 22.3%; HR: 1.79; 95% CI: 1.49-2.16; P < 0.001). After adjustment, an HCL remained an independent predictor of 10-year mortality (HR: 1.36; 95% CI: 1.09-1.69; P = 0.006). There was a significant interaction in mortality between treatment effect (PCI and CABG) and the presence or absence of HCLs (Pinteraction = 0.005). In patients without HCLs, mortality was significantly higher after PCI than after CABG (26.0% vs 18.8%; HR: 1.44; 95% CI: 0.97-1.41; P = 0.003), whereas in those with HCLs, there was no significant difference (34.0% vs 39.0%; HR: 0.85; 95% CI: 0.64-1.13; P = 0.264). Conclusions: At 10 years, the presence of an HCL was an independent predictor of mortality, with a similar prognosis following PCI or CABG. Whether HCLs require special consideration when deciding the mode of revascularization beyond their current contribution to the anatomical SYNTAX score deserves further evaluation.

KW - calcification

KW - coronary artery bypass grafting

KW - long-term mortality

KW - percutaneous coronary intervention

KW - SYNTAX

UR - https://www.scopus.com/pages/publications/85122611129

U2 - 10.1016/j.jcin.2021.10.026

DO - 10.1016/j.jcin.2021.10.026

M3 - Article

C2 - 34973904

AN - SCOPUS:85122611129

SN - 1936-8798

VL - 15

SP - 193

EP - 204

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 2

ER -

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

Abstract

UN SDGs

Keywords

Access to Document

Other files and links

Fingerprint

Cite this