Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization

Rutao Wang; Mattia Lunardi; Hironori Hara; Chao Gao; Masafumi Ono; Piroze M. Davierwala; David R. Holmes; Friedrich W. Mohr; Nick Curzen; Francesco Burzotta; Robert Jan van Geuns; Arie Pieter Kappetein; Stuart J. Head; Daniel J.F.M. Thuijs; Ling Tao; Scot Garg; Yoshinobu Onuma; William Wijns; Patrick W. Serruys

doi:10.1007/s00392-023-02211-6

Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization

Rutao Wang, Mattia Lunardi, Hironori Hara, Chao Gao, Masafumi Ono, Piroze M. Davierwala, David R. Holmes, Friedrich W. Mohr, Nick Curzen, Francesco Burzotta, Robert Jan van Geuns, Arie Pieter Kappetein, Stuart J. Head, Daniel J.F.M. Thuijs, Ling Tao, Scot Garg, Yoshinobu Onuma, William Wijns, Patrick W. Serruys

Cardiovascular Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: The SYNTAX trial demonstrated negative impact of repeat revascularization (RR) on 5-year outcomes following PCI/CABG in patients with three-vessel(3VD) and/or left main coronary artery disease(LMCAD). We aimed to investigate the impact of RR within 5 years, on 10-year mortality in patients with 3VD and/or LMCAD after PCI/CABG. Methods: The SYNTAXES study evaluated the vital status out to 10 years of patients with 3VD and/or LMCAD. Patients were stratified by RR within 5 years and randomized treatment. The association between RR within 5 years and 10-year mortality was assessed. Results: A total of 330 out of 1800 patients (18.3%) underwent RR within 5 years. RR occurred more frequently after initial PCI than after initial CABG (25.9% vs. 13.7%, p < 0.001). Overall, 10-year mortality was comparable between patients undergoing RR and those not (28.2% vs. 26.1%, adjusted HR: 1.17, 95%CI 0.93–1.48, p = 0.187). In the PCI arm, RR was associated with a trend toward higher 10-year mortality (adjusted HR: 1.29, 95%CI 0.97–1.72, p = 0.075), while in the CABG arm, the trend was opposite (adjusted HR: 0.74, 95%CI 0.46–1.20, p = 0.219). Among patients requiring RR, those who underwent PCI as initial revascularization had a higher risk of 10-year mortality compared to initial CABG (33.5% vs. 17.6%, adjusted HR: 2.09, 95%CI 1.21–3.61, p = 0.008). Conclusion: In the SYNTAXES study, RR within 5 years had no impact on 10-year all-cause death in the population overall. Among patients requiring any repeat procedures, 10-year mortality was higher after initial treatment with PCI than after CABG. These exploratory findings should be investigated with larger populations in future studies. Trial registration: URL: https://www.clinicaltrials.gov ; SYNTAXES Unique identifier: NCT03417050. URL: https://www.clinicaltrials.gov ; SYNTAX Unique identifier: NCT00114972. Graphical abstract: [Figure not available: see fulltext.].

Original language	English (US)
Pages (from-to)	1302-1311
Number of pages	10
Journal	Clinical Research in Cardiology
Volume	112
Issue number	9
DOIs	https://doi.org/10.1007/s00392-023-02211-6
State	Published - Sep 2023

Keywords

All-cause death
Coronary artery bypass grafting
Percutaneous coronary intervention
Repeat revascularization
SYNTAX

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1007/s00392-023-02211-6

Cite this

Wang, R., Lunardi, M., Hara, H., Gao, C., Ono, M., Davierwala, P. M., Holmes, D. R., Mohr, F. W., Curzen, N., Burzotta, F., van Geuns, R. J., Kappetein, A. P., Head, S. J., Thuijs, D. J. F. M., Tao, L., Garg, S., Onuma, Y., Wijns, W., & Serruys, P. W. (2023). Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization. Clinical Research in Cardiology, 112(9), 1302-1311. https://doi.org/10.1007/s00392-023-02211-6

Wang, R, Lunardi, M, Hara, H, Gao, C, Ono, M, Davierwala, PM, Holmes, DR, Mohr, FW, Curzen, N, Burzotta, F, van Geuns, RJ, Kappetein, AP, Head, SJ, Thuijs, DJFM, Tao, L, Garg, S, Onuma, Y, Wijns, W & Serruys, PW 2023, 'Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization', Clinical Research in Cardiology, vol. 112, no. 9, pp. 1302-1311. https://doi.org/10.1007/s00392-023-02211-6

@article{369ed49528c84ce99965d2d7834cd6ef,

title = "Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization",

abstract = "Background: The SYNTAX trial demonstrated negative impact of repeat revascularization (RR) on 5-year outcomes following PCI/CABG in patients with three-vessel(3VD) and/or left main coronary artery disease(LMCAD). We aimed to investigate the impact of RR within 5 years, on 10-year mortality in patients with 3VD and/or LMCAD after PCI/CABG. Methods: The SYNTAXES study evaluated the vital status out to 10 years of patients with 3VD and/or LMCAD. Patients were stratified by RR within 5 years and randomized treatment. The association between RR within 5 years and 10-year mortality was assessed. Results: A total of 330 out of 1800 patients (18.3%) underwent RR within 5 years. RR occurred more frequently after initial PCI than after initial CABG (25.9% vs. 13.7%, p < 0.001). Overall, 10-year mortality was comparable between patients undergoing RR and those not (28.2% vs. 26.1%, adjusted HR: 1.17, 95%CI 0.93–1.48, p = 0.187). In the PCI arm, RR was associated with a trend toward higher 10-year mortality (adjusted HR: 1.29, 95%CI 0.97–1.72, p = 0.075), while in the CABG arm, the trend was opposite (adjusted HR: 0.74, 95%CI 0.46–1.20, p = 0.219). Among patients requiring RR, those who underwent PCI as initial revascularization had a higher risk of 10-year mortality compared to initial CABG (33.5% vs. 17.6%, adjusted HR: 2.09, 95%CI 1.21–3.61, p = 0.008). Conclusion: In the SYNTAXES study, RR within 5 years had no impact on 10-year all-cause death in the population overall. Among patients requiring any repeat procedures, 10-year mortality was higher after initial treatment with PCI than after CABG. These exploratory findings should be investigated with larger populations in future studies. Trial registration: URL: https://www.clinicaltrials.gov ; SYNTAXES Unique identifier: NCT03417050. URL: https://www.clinicaltrials.gov ; SYNTAX Unique identifier: NCT00114972. Graphical abstract: [Figure not available: see fulltext.].",

keywords = "All-cause death, Coronary artery bypass grafting, Percutaneous coronary intervention, Repeat revascularization, SYNTAX",

author = "Rutao Wang and Mattia Lunardi and Hironori Hara and Chao Gao and Masafumi Ono and Davierwala, {Piroze M.} and Holmes, {David R.} and Mohr, {Friedrich W.} and Nick Curzen and Francesco Burzotta and {van Geuns}, {Robert Jan} and Kappetein, {Arie Pieter} and Head, {Stuart J.} and Thuijs, {Daniel J.F.M.} and Ling Tao and Scot Garg and Yoshinobu Onuma and William Wijns and Serruys, {Patrick W.}",

note = "Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = sep,

doi = "10.1007/s00392-023-02211-6",

language = "English (US)",

volume = "112",

pages = "1302--1311",

journal = "Clinical Research in Cardiology",

issn = "1861-0684",

publisher = "D. Steinkopff-Verlag",

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TY - JOUR

T1 - Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization

AU - Wang, Rutao

AU - Lunardi, Mattia

AU - Hara, Hironori

AU - Gao, Chao

AU - Ono, Masafumi

AU - Davierwala, Piroze M.

AU - Holmes, David R.

AU - Mohr, Friedrich W.

AU - Curzen, Nick

AU - Burzotta, Francesco

AU - van Geuns, Robert Jan

AU - Kappetein, Arie Pieter

AU - Head, Stuart J.

AU - Thuijs, Daniel J.F.M.

AU - Tao, Ling

AU - Garg, Scot

AU - Onuma, Yoshinobu

AU - Wijns, William

AU - Serruys, Patrick W.

PY - 2023/9

Y1 - 2023/9

N2 - Background: The SYNTAX trial demonstrated negative impact of repeat revascularization (RR) on 5-year outcomes following PCI/CABG in patients with three-vessel(3VD) and/or left main coronary artery disease(LMCAD). We aimed to investigate the impact of RR within 5 years, on 10-year mortality in patients with 3VD and/or LMCAD after PCI/CABG. Methods: The SYNTAXES study evaluated the vital status out to 10 years of patients with 3VD and/or LMCAD. Patients were stratified by RR within 5 years and randomized treatment. The association between RR within 5 years and 10-year mortality was assessed. Results: A total of 330 out of 1800 patients (18.3%) underwent RR within 5 years. RR occurred more frequently after initial PCI than after initial CABG (25.9% vs. 13.7%, p < 0.001). Overall, 10-year mortality was comparable between patients undergoing RR and those not (28.2% vs. 26.1%, adjusted HR: 1.17, 95%CI 0.93–1.48, p = 0.187). In the PCI arm, RR was associated with a trend toward higher 10-year mortality (adjusted HR: 1.29, 95%CI 0.97–1.72, p = 0.075), while in the CABG arm, the trend was opposite (adjusted HR: 0.74, 95%CI 0.46–1.20, p = 0.219). Among patients requiring RR, those who underwent PCI as initial revascularization had a higher risk of 10-year mortality compared to initial CABG (33.5% vs. 17.6%, adjusted HR: 2.09, 95%CI 1.21–3.61, p = 0.008). Conclusion: In the SYNTAXES study, RR within 5 years had no impact on 10-year all-cause death in the population overall. Among patients requiring any repeat procedures, 10-year mortality was higher after initial treatment with PCI than after CABG. These exploratory findings should be investigated with larger populations in future studies. Trial registration: URL: https://www.clinicaltrials.gov ; SYNTAXES Unique identifier: NCT03417050. URL: https://www.clinicaltrials.gov ; SYNTAX Unique identifier: NCT00114972. Graphical abstract: [Figure not available: see fulltext.].

AB - Background: The SYNTAX trial demonstrated negative impact of repeat revascularization (RR) on 5-year outcomes following PCI/CABG in patients with three-vessel(3VD) and/or left main coronary artery disease(LMCAD). We aimed to investigate the impact of RR within 5 years, on 10-year mortality in patients with 3VD and/or LMCAD after PCI/CABG. Methods: The SYNTAXES study evaluated the vital status out to 10 years of patients with 3VD and/or LMCAD. Patients were stratified by RR within 5 years and randomized treatment. The association between RR within 5 years and 10-year mortality was assessed. Results: A total of 330 out of 1800 patients (18.3%) underwent RR within 5 years. RR occurred more frequently after initial PCI than after initial CABG (25.9% vs. 13.7%, p < 0.001). Overall, 10-year mortality was comparable between patients undergoing RR and those not (28.2% vs. 26.1%, adjusted HR: 1.17, 95%CI 0.93–1.48, p = 0.187). In the PCI arm, RR was associated with a trend toward higher 10-year mortality (adjusted HR: 1.29, 95%CI 0.97–1.72, p = 0.075), while in the CABG arm, the trend was opposite (adjusted HR: 0.74, 95%CI 0.46–1.20, p = 0.219). Among patients requiring RR, those who underwent PCI as initial revascularization had a higher risk of 10-year mortality compared to initial CABG (33.5% vs. 17.6%, adjusted HR: 2.09, 95%CI 1.21–3.61, p = 0.008). Conclusion: In the SYNTAXES study, RR within 5 years had no impact on 10-year all-cause death in the population overall. Among patients requiring any repeat procedures, 10-year mortality was higher after initial treatment with PCI than after CABG. These exploratory findings should be investigated with larger populations in future studies. Trial registration: URL: https://www.clinicaltrials.gov ; SYNTAXES Unique identifier: NCT03417050. URL: https://www.clinicaltrials.gov ; SYNTAX Unique identifier: NCT00114972. Graphical abstract: [Figure not available: see fulltext.].

KW - All-cause death

KW - Coronary artery bypass grafting

KW - Percutaneous coronary intervention

KW - Repeat revascularization

KW - SYNTAX

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