Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland.
Clin Res Cardiol. 2023 Sep;112(9):1302-1311. doi: 10.1007/s00392-023-02211-6. Epub 2023 May 8.
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.
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.
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).
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.
URL: https://www.
gov ; SYNTAXES Unique identifier: NCT03417050. URL: https://www.
gov ; SYNTAX Unique identifier: NCT00114972.
SYNTAX 试验表明，在接受经皮冠状动脉介入治疗（PCI）/冠状动脉旁路移植术（CABG）治疗的三血管病变（3VD）和/或左主干冠状动脉疾病（LMCAD）患者中，重复血运重建（RR）对 5 年后的结局有负面影响。我们旨在研究 RR 在 5 年内对接受 PCI/CABG 治疗的 3VD 和/或 LMCAD 患者 10 年后死亡率的影响。
SYNTAXES 研究评估了 3VD 和/或 LMCAD 患者 10 年的生存状况。根据 RR 在 5 年内的分层情况，将患者随机分为治疗组。评估 RR 在 5 年内与 10 年死亡率之间的关系。
在 1800 例患者中，共有 330 例（18.3%）在 5 年内接受了 RR。初始 PCI 后 RR 发生的频率高于初始 CABG（25.9% vs. 13.7%，p<0.001）。总的来说，RR 组和非 RR 组的 10 年死亡率相当（28.2% vs. 26.1%，调整后的 HR：1.17，95%CI 0.93-1.48，p=0.187）。在 PCI 组中，RR 与 10 年死亡率呈上升趋势（调整后的 HR：1.29，95%CI 0.97-1.72，p=0.075），而在 CABG 组中，这一趋势相反（调整后的 HR：0.74，95%CI 0.46-1.20，p=0.219）。在需要 RR 的患者中，与初始 CABG 相比，初始 PCI 作为再血管化治疗的患者 10 年死亡率更高（33.5% vs. 17.6%，调整后的 HR：2.09，95%CI 1.21-3.61，p=0.008）。
在 SYNTAXES 研究中，RR 在 5 年内对总体人群的 10 年全因死亡没有影响。在需要重复治疗的患者中，与初始 CABG 相比，初始 PCI 后 10 年死亡率更高。这些探索性发现应在未来的研究中用更大的人群进行研究。
网址：https://www.clinicaltrials.gov；SYNTAXES 唯一标识符：NCT03417050。网址：https://www.clinicaltrials.gov；SYNTAX 唯一标识符：NCT00114972。
