Impact of chronic obstructive pulmonary disease on 10-year mortality after percutaneous coronary intervention and bypass surgery for complex coronary artery disease: insights from the SYNTAX Extended Survival study

Rutao Wang, Mariusz Tomaniak, Kuniaki Takahashi, Chao Gao, Hideyuki Kawashima, Hironori Hara, Masafumi Ono, David van Klaveren, Robert Jan van Geuns, Marie Claude Morice, Piroze M. Davierwala, Michael J. Mack, Adam Witkowski, Nick Curzen, Sergio Berti, Francesco Burzotta, Stefan James, Arie Pieter Kappetein, Stuart J. Head, Daniel J.F.M. ThuijsFriedrich W. Mohr, David R. Holmes, Ling Tao, Yoshinobu Onuma, Patrick W. Serruys

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: To evaluate the impact of chronic obstructive pulmonary disease (COPD) on 10-year all-cause death and the treatment effect of CABG versus PCI on 10-year all-cause death in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) and COPD. Methods: Patients were stratified according to COPD status and compared with regard to clinical outcomes. Ten-year all-cause death was examined according to the presence of COPD and the revascularization strategy. Results: COPD status was available for all randomized 1800 patients, of whom, 154 had COPD (8.6%) at the time of randomization. Regardless of the revascularization strategy, patients with COPD had a higher risk of 10-year all-cause death, compared with those without COPD (43.1% vs. 24.9%; hazard ratio [HR]: 2.03; 95% confidence interval [CI]: 1.56–2.64; p < 0.001). Among patients with COPD, CABG appeared to have a slightly lower risk of 10-year all-cause death compared with PCI (42.3% vs. 43.9%; HR: 0.96; 95% CI: 0.59–1.56, p = 0.858), whereas among those without COPD, CABG had a significantly lower risk of 10-year all-cause death (22.7% vs. 27.1%; HR: 0.81; 95% CI: 0.67–0.99, p = 0.041). There was no significant differential treatment effect of CABG versus PCI on 10-year all-cause death between patients with and without COPD (pinteraction = 0.544). Conclusions: COPD was associated with a higher risk of 10-year all-cause death after revascularization for complex coronary artery disease. The presence of COPD did not significantly modify the beneficial effect of CABG versus PCI on 10-year all-cause death. Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050 Graphic abstract: [Figure not available: see fulltext.]

Original languageEnglish (US)
JournalClinical Research in Cardiology
DOIs
StateAccepted/In press - 2021

Keywords

  • All-cause death
  • Chronic obstructive pulmonary disease
  • Coronary artery bypass grafting
  • Percutaneous coronary intervention
  • SYNTAX

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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