RT Journal Article
SR Electronic
T1 Mortality after multivessel revascularisation involving the proximal left anterior descending artery
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP heartjnl-2022-320934
DO 10.1136/heartjnl-2022-320934
A1 Masafumi Ono
A1 Hironori Hara
A1 Chao Gao
A1 Hideyuki Kawashima
A1 Rutao Wang
A1 Neil O’Leary
A1 Joanna J Wykrzykowska
A1 Jan J Piek
A1 Michael J Mack
A1 David Holmes
A1 Marie-Claude Morice
A1 Stuart Head
A1 Arie Pieter Kappetein
A1 Thilo Noack
A1 Piroze M Davierwala
A1 Friedrich W Mohr
A1 Scot Garg
A1 Yoshinobu Onuma
A1 Patrick W Serruys
A1 ,
YR 2022
UL http://heart.bmj.com/content/early/2022/06/21/heartjnl-2022-320934.abstract
AB Objective We sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD).Methods This post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed.Results Among 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, pinteraction=0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; pinteraction=0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality.Conclusions Among patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG.Trial registration number SYNTAXES: NCT03417050; SYNTAX: NCT00114972.Data are available upon reasonable request. Anonymised data that support the findings of this study are available from the corresponding author on reasonable request.