TY - JOUR
T1 - Sex Differences in All-Cause Mortality in the Decade Following Complex Coronary Revascularization
AU - SYNTAX Extended Survival Investigators
AU - Hara, Hironori
AU - Takahashi, Kuniaki
AU - van Klaveren, David
AU - Wang, Rutao
AU - Garg, Scot
AU - Ono, Masafumi
AU - Kawashima, Hideyuki
AU - Gao, Chao
AU - Mack, Michael
AU - Holmes, David R.
AU - Morice, Marie Claude
AU - Head, Stuart J.
AU - Kappetein, Arie Pieter
AU - Thuijs, Daniel J.F.M.
AU - Onuma, Yoshinobu
AU - Noack, Thilo
AU - Mohr, Friedrich W.
AU - Davierwala, Piroze M.
AU - Serruys, Patrick W.
N1 - Funding Information:
The SYNTAX Extended Survival study was supported by the German Foundation of Heart Research. The SYNTAX trial, during 0- to 5-year follow-up, was funded by Boston Scientific. Both sponsors had no role in study design, data collection, data analyses, and interpretation of the study data, nor were they involved in the decision to publish the final manuscript. The principal investigators and authors had complete scientific freedom. Dr. Hara has received a grant for studying overseas from the Japanese Circulation Society and a grant from the Fukuda Foundation for Medical Technology. Dr. Head is an employee of Medtronic, outside the submitted work. Dr. Morice is CEO and a shareholder of CERC, a contract research organization based in Massy, France, outside the submitted work. Dr. Kappetein is an employee of Medtronic, outside the submitted work. Dr. Serruys has received personal fees from Biosensors, Micel Technologies, Sinomedical Sciences Technology, Philips/Volcano, Xeltis, and HeartFlow, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Binita Shah, MD, served as Guest Associate Editor for this paper. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper.
Funding Information:
The SYNTAX Extended Survival study was supported by the German Foundation of Heart Research. The SYNTAX trial, during 0- to 5-year follow-up, was funded by Boston Scientific. Both sponsors had no role in study design, data collection, data analyses, and interpretation of the study data, nor were they involved in the decision to publish the final manuscript. The principal investigators and authors had complete scientific freedom. Dr. Hara has received a grant for studying overseas from the Japanese Circulation Society and a grant from the Fukuda Foundation for Medical Technology. Dr. Head is an employee of Medtronic, outside the submitted work. Dr. Morice is CEO and a shareholder of CERC, a contract research organization based in Massy, France, outside the submitted work. Dr. Kappetein is an employee of Medtronic, outside the submitted work. Dr. Serruys has received personal fees from Biosensors, Micel Technologies, Sinomedical Sciences Technology, Philips/Volcano, Xeltis, and HeartFlow, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Binita Shah, MD, served as Guest Associate Editor for this paper. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper.
Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/8/25
Y1 - 2020/8/25
N2 - Background: The poorer prognosis of coronary artery disease in females compared with males is related mainly to differences in baseline characteristics. In the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, the effect of treatment with percutaneous coronary intervention (PCI) versus coronary artery bypass grafting surgery (CABG) on mortality at 5 years differed significantly between females and males; however, the optimal revascularization beyond 5 years according to sex has not been evaluated. Objectives: The aim of this study was to investigate the impact of sex on mortality and sex-treatment interaction at 10 years. Methods: The SYNTAXES (SYNTAX Extended Survival) study evaluated vital status up to 10 years in 1,800 patients with de novo 3-vessel and/or left main coronary artery disease randomized to treatment with PCI or CABG in the SYNTAX trial. All-cause death at 10 years was separately evaluated in female and male patients with complex coronary artery disease. Results: Of 1,800 patients, 402 (22.3%) were female and 1,398 (77.7%) were males. Females had a higher 10-year mortality rate compared with males (32.8% vs. 24.7%; log-rank p = 0.002), but female sex was not an independent predictor of mortality (adjusted hazard ratio: 1.02; 95% confidence interval: 0.76 to 1.36). Mortality at 10 years tended to be lower after CABG than after PCI, with a similar treatment effect for female and male patients (adjusted hazard ratio for females: 0.90 [95% confidence interval: 0.54 to 1.51]; adjusted hazard ratio for males: 0.76 [95% confidence interval: 0.56 to 1.02]; p for interaction = 0.952). Conclusions: Female sex was not an independent predictor of mortality at 10 years in patients with complex coronary artery disease. The interaction between sex and treatment with PCI or CABG that was observed at 5 years was no longer present at 10 years. (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)
AB - Background: The poorer prognosis of coronary artery disease in females compared with males is related mainly to differences in baseline characteristics. In the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, the effect of treatment with percutaneous coronary intervention (PCI) versus coronary artery bypass grafting surgery (CABG) on mortality at 5 years differed significantly between females and males; however, the optimal revascularization beyond 5 years according to sex has not been evaluated. Objectives: The aim of this study was to investigate the impact of sex on mortality and sex-treatment interaction at 10 years. Methods: The SYNTAXES (SYNTAX Extended Survival) study evaluated vital status up to 10 years in 1,800 patients with de novo 3-vessel and/or left main coronary artery disease randomized to treatment with PCI or CABG in the SYNTAX trial. All-cause death at 10 years was separately evaluated in female and male patients with complex coronary artery disease. Results: Of 1,800 patients, 402 (22.3%) were female and 1,398 (77.7%) were males. Females had a higher 10-year mortality rate compared with males (32.8% vs. 24.7%; log-rank p = 0.002), but female sex was not an independent predictor of mortality (adjusted hazard ratio: 1.02; 95% confidence interval: 0.76 to 1.36). Mortality at 10 years tended to be lower after CABG than after PCI, with a similar treatment effect for female and male patients (adjusted hazard ratio for females: 0.90 [95% confidence interval: 0.54 to 1.51]; adjusted hazard ratio for males: 0.76 [95% confidence interval: 0.56 to 1.02]; p for interaction = 0.952). Conclusions: Female sex was not an independent predictor of mortality at 10 years in patients with complex coronary artery disease. The interaction between sex and treatment with PCI or CABG that was observed at 5 years was no longer present at 10 years. (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)
KW - CABG
KW - PCI
KW - SYNTAX
KW - sex
KW - survival
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U2 - 10.1016/j.jacc.2020.06.066
DO - 10.1016/j.jacc.2020.06.066
M3 - Article
C2 - 32819461
AN - SCOPUS:85089222130
SN - 0735-1097
VL - 76
SP - 889
EP - 899
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 8
ER -