| Institution: | 1. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;2. Department of Cardiology, National University of Ireland, Galway, Galway, Ireland;3. Department of Cardiology, Radboud University, Nijmegen, the Netherlands;4. Department of Cardiothoracic Surgery, Baylor Scott and White Health, Dallas, Texas, USA;5. Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA;6. Département of Cardiologie, Hôpital Privé Jacques Cartier, Générale de Santé Massy, France;7. Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands;8. Department of Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia;9. University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany;10. National Heart and Lung Institute, Imperial College London, London, United Kingdom |
| Abstract: | BackgroundThe long-term clinical benefit after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with total occlusions (TOs) and complex coronary artery disease has not yet been clarified.ObjectivesThe objective of this analysis was to assess 10-year all-cause mortality in patients with TOs undergoing PCI or CABG.MethodsThis is a subanalysis of patients with at least 1 TO in the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which investigated 10-year all-cause mortality in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial, beyond its original 5-year follow-up. Patients with TOs were further stratified according to the status of TO recanalization or revascularization.ResultsOf 1,800 randomized patients to the PCI or CABG arm, 460 patients had at least 1 lesion of TO. In patients with TOs, the status of TO recanalization or revascularization was not associated with 10-year all-cause mortality, irrespective of the assigned treatment (PCI arm: 29.9% vs. 29.4%; adjusted hazard ratio HR]: 0.992; 95% confidence interval CI]: 0.474 to 2.075; p = 0.982; and CABG arm: 28.0% vs. 21.4%; adjusted HR: 0.656; 95% CI: 0.281 to 1.533; p = 0.330). When TOs existed in left main and/or left anterior descending artery, the status of TO recanalization or revascularization did not have an impact on the mortality (34.5% vs. 26.9%; adjusted HR: 0.896; 95% CI: 0.314 to 2.555; p = 0.837).ConclusionsAt 10-year follow-up, the status of TO recanalization or revascularization did not affect mortality, irrespective of the assigned treatment and location of TOs. The present study might support contemporary practice among high-volume chronic TO-PCI centers where recanalization is primarily offered to patients for the management of angina refractory to medical therapy when myocardial viability is confirmed. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries SYNTAX]; NCT00114972) |
