TY - JOUR
T1 - Causes of Death Following PCI Versus CABG in Complex CAD 5-Year Follow-Up of SYNTAX
AU - Milojevic, Milan
AU - Head, Stuart J.
AU - Parasca, Catalina A.
AU - Serruys, Patrick W.
AU - Mohr, Friedrich W.
AU - Morice, Marie Claude
AU - Mack, Michael J.
AU - Ståhle, Elisabeth
AU - Feldman, Ted E.
AU - Dawkins, Keith D.
AU - Colombo, Antonio
AU - Kappetein, A. Pieter
AU - Holmes, David R.
N1 - Publisher Copyright:
© 2016 American College of Cardiology Foundation.
PY - 2016/1/5
Y1 - 2016/1/5
N2 - Background There are no data available on specific causes of death from randomized trials that have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI). Objectives The purpose of this study was to investigate specific causes of death, and its predictors, after revascularization for complex coronary disease in patients. Methods An independent Clinical Events Committee consisting of expert physicians who were blinded to the study treatment subclassified causes of death as cardiovascular (cardiac and vascular), noncardiovascular, or undetermined according to the trial protocol. Cardiac deaths were classified as sudden cardiac, related to myocardial infarction (MI), and other cardiac deaths. Results In the randomized cohort, there were 97 deaths after CABG and 123 deaths after PCI during a 5-year follow-up. After CABG, 49.4% of deaths were cardiovascular, with the greatest cause being heart failure, arrhythmia, or other causes (24.6%), whereas after PCI, the majority of deaths were cardiovascular (67.5%) and as a result of MI (29.3%). The cumulative incidence rates of all-cause death were not significantly different between CABG and PCI (11.4% vs. 13.9%, respectively; p = 0.10), whereas there were significant differences in terms of cardiovascular (5.8% vs. 9.6%, respectively; p = 0.008) and cardiac death (5.3% vs. 9.0%, respectively; p = 0.003), which were caused primarily by a reduction in MI-related death with CABG compared with PCI (0.4% vs. 4.1%, respectively; p <0.0001). Treatment with PCI versus CABG was an independent predictor of cardiac death (hazard ratio: 1.55; 95% confidence interval: 1.09 to 2.33; p = 0.045). The difference in MI-related death was seen largely in patients with diabetes, 3-vessel disease, or high SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries) trial scores. Conclusions During a 5-year follow-up, CABG in comparison with PCI was associated with a significantly reduced rate of MI-related death, which was the leading cause of death after PCI. Treatments following PCI should target reducing post-revascularization spontaneous MI. Furthermore, secondary preventive medication remains essential in reducing events post-revascularization.
AB - Background There are no data available on specific causes of death from randomized trials that have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI). Objectives The purpose of this study was to investigate specific causes of death, and its predictors, after revascularization for complex coronary disease in patients. Methods An independent Clinical Events Committee consisting of expert physicians who were blinded to the study treatment subclassified causes of death as cardiovascular (cardiac and vascular), noncardiovascular, or undetermined according to the trial protocol. Cardiac deaths were classified as sudden cardiac, related to myocardial infarction (MI), and other cardiac deaths. Results In the randomized cohort, there were 97 deaths after CABG and 123 deaths after PCI during a 5-year follow-up. After CABG, 49.4% of deaths were cardiovascular, with the greatest cause being heart failure, arrhythmia, or other causes (24.6%), whereas after PCI, the majority of deaths were cardiovascular (67.5%) and as a result of MI (29.3%). The cumulative incidence rates of all-cause death were not significantly different between CABG and PCI (11.4% vs. 13.9%, respectively; p = 0.10), whereas there were significant differences in terms of cardiovascular (5.8% vs. 9.6%, respectively; p = 0.008) and cardiac death (5.3% vs. 9.0%, respectively; p = 0.003), which were caused primarily by a reduction in MI-related death with CABG compared with PCI (0.4% vs. 4.1%, respectively; p <0.0001). Treatment with PCI versus CABG was an independent predictor of cardiac death (hazard ratio: 1.55; 95% confidence interval: 1.09 to 2.33; p = 0.045). The difference in MI-related death was seen largely in patients with diabetes, 3-vessel disease, or high SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries) trial scores. Conclusions During a 5-year follow-up, CABG in comparison with PCI was associated with a significantly reduced rate of MI-related death, which was the leading cause of death after PCI. Treatments following PCI should target reducing post-revascularization spontaneous MI. Furthermore, secondary preventive medication remains essential in reducing events post-revascularization.
KW - Key Words cardiac death
KW - SYNTAX
KW - cause of death
KW - coronary artery bypass grafting
KW - heart failure
KW - myocardial infarction
KW - percutaneous coronary intervention
KW - stroke
KW - sudden death
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UR - http://www.scopus.com/inward/citedby.url?scp=84952908312&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2015.10.043
DO - 10.1016/j.jacc.2015.10.043
M3 - Article
C2 - 26764065
AN - SCOPUS:84952908312
SN - 0735-1097
VL - 67
SP - 42
EP - 55
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -