Mortality 10 Years After Percutaneous or Surgical Revascularization in Patients With Total Coronary Artery Occlusions

被引：29

作者：

Kawashima, Hideyuki ^{[1
,2
]}

Takahashi, Kuniaki ^{[1
]}

Ono, Masafumi ^{[1
,2
]}

Hara, Hironori ^{[1
]}

Wang, Rutao ^{[2
,3
]}

Gao, Chao ^{[2
,3
]}

Sharif, Faisal ^{[2
]}

Mack, Michael J. ^{[4
]}

Holmes, David R. ^{[5
]}

Morice, Marie-Claude ^{[6
]}

Head, Stuart J. ^{[7
]}

Kappetein, Arie Pieter ^{[7
]}

Thuijs, Daniel J. F. M. ^{[7
]}

Milojevic, Milan ^{[7
,8
]}

Noack, Thilo ^{[9
]}

Mohr, Friedrich-Wilhelm ^{[9
]}

Davierwala, Piroze M. ^{[9
]}

Serruys, Patrick W. ^{[2
,10
]}

Onuma, Yoshinobu ^{[2
]}

机构：

[1] Univ Amsterdam, Acad Med Ctr, Dept Cardiol, Amsterdam, Netherlands

[2] Natl Univ Ireland, Dept Cardiol, Galway, Ireland

[3] Radboud Univ Nijmegen, Dept Cardiol, Nijmegen, Netherlands

[4] Baylor Scott & White Hlth, Dept Cardiothorac Surg, Dallas, TX USA

[5] Mayo Clin, Dept Cardiovasc Dis & Internal Med, Rochester, MN USA

[6] Hop Prive Jacques Cartier, Gen Sante Massy, Dept Cardiol, Massy, France

[7] Erasmus MC, Dept Cardiothorac Surg, Rotterdam, Netherlands

[8] Dedinje Cardiovasc Inst, Dept Cardiovasc Res, Belgrade, Serbia

[9] Univ Dept Cardiac Surg, Heart Ctr Leipzig, Leipzig, Germany

[10] Imperial Coll London, Natl Heart & Lung Inst, London, England

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2021年 / 77卷 / 05期

关键词：

coronary artery bypass grafting; long-term mortality; percutaneous coronary intervention; SYNTAX; total occlusion; CARDIAC-SURGERY SYNTAX; LONG-TERM OUTCOMES; QUALITY-OF-LIFE; CLINICAL-OUTCOMES; DECISION-MAKING; FOLLOW-UP; INTERVENTION; SCORE; VALIDATION; REGISTRY;

D O I：

10.1016/j.jacc.2020.11.055

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The long-term clinical benefit after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with total occlusions (TOs) and complex coronary artery disease has not yet been clarified. OBJECTIVES The objective of this analysis was to assess 10-year all-cause mortality in patients with TOs undergoing PCI or CABG. METHODS This is a subanalysis of patients with at least 1 TO in the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which investigated 10-year all-cause mortality in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial, beyond its original 5-year follow-up. Patients with TOs were further stratified according to the status of TO recanalization or revascularization. RESULTS Of 1,800 randomized patients to the PCI or CABG arm, 460 patients had at least 1 lesion of TO. In patients with TOs, the status of TO recanalization or revascularization was not associated with 10-year all-cause mortality, irrespective of the assigned treatment (PCI arm: 29.9% vs. 29.4%; adjusted hazard ratio [HR]: 0.992; 95% confidence interval [CI]: 0.474 to 2.075; p = 0.982; and CABG arm: 28.0% vs. 21.4%; adjusted HR: 0.656; 95% CI: 0.281 to 1.533; p = 0.330). When TOs existed in left main and/or left anterior descending artery, the status of TO recanalization or revascularization did not have an impact on the mortality (34.5% vs. 26.9%; adjusted HR: 0.896; 95% CI: 0.314 to 2.555; p = 0.837). CONCLUSIONS At 10-year follow-up, the status of TO recanalization or revascularization did not affect mortality, irrespective of the assigned treatment and location of TOs. The present study might support contemporary practice among high-volume chronic TO-PCI centers where recanalization is primarily offered to patients for the management of angina refractory to medical therapy when myocardial viability is confirmed. (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) (C) 2021 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

引用

页码：529 / 540

页数：12

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