Original Investigation
Causes of Death Following PCI Versus CABG in Complex CAD: 5-Year Follow-Up of SYNTAX

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Abstract

Background

There are no data available on specific causes of death from randomized trials that have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI).

Objectives

The purpose of this study was to investigate specific causes of death, and its predictors, after revascularization for complex coronary disease in patients.

Methods

An independent Clinical Events Committee consisting of expert physicians who were blinded to the study treatment subclassified causes of death as cardiovascular (cardiac and vascular), noncardiovascular, or undetermined according to the trial protocol. Cardiac deaths were classified as sudden cardiac, related to myocardial infarction (MI), and other cardiac deaths.

Results

In the randomized cohort, there were 97 deaths after CABG and 123 deaths after PCI during a 5-year follow-up. After CABG, 49.4% of deaths were cardiovascular, with the greatest cause being heart failure, arrhythmia, or other causes (24.6%), whereas after PCI, the majority of deaths were cardiovascular (67.5%) and as a result of MI (29.3%). The cumulative incidence rates of all-cause death were not significantly different between CABG and PCI (11.4% vs. 13.9%, respectively; p = 0.10), whereas there were significant differences in terms of cardiovascular (5.8% vs. 9.6%, respectively; p = 0.008) and cardiac death (5.3% vs. 9.0%, respectively; p = 0.003), which were caused primarily by a reduction in MI-related death with CABG compared with PCI (0.4% vs. 4.1%, respectively; p <0.0001). Treatment with PCI versus CABG was an independent predictor of cardiac death (hazard ratio: 1.55; 95% confidence interval: 1.09 to 2.33; p = 0.045). The difference in MI-related death was seen largely in patients with diabetes, 3-vessel disease, or high SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries) trial scores.

Conclusions

During a 5-year follow-up, CABG in comparison with PCI was associated with a significantly reduced rate of MI-related death, which was the leading cause of death after PCI. Treatments following PCI should target reducing post-revascularization spontaneous MI. Furthermore, secondary preventive medication remains essential in reducing events post-revascularization. (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972)

Key Words

cardiac death
cause of death
coronary artery bypass grafting
heart failure
myocardial infarction
percutaneous coronary intervention
stroke
sudden death
SYNTAX

Abbreviations and Acronyms

3VD
3-vessel disease
CABG
coronary artery bypass grafting
CAD
coronary artery disease
CEC
Clinical Events Committee
CHF
congestive heart failure
CI
confidence interval
DES
drug-eluting stent
HR
hazard ratio
LM
left main
MI
myocardial infarction
PCI
percutaneous coronary intervention

Cited by (0)

This study was supported by Boston Scientific. Dr. Feldman has received consulting and lecture fees, and research support from Boston Scientific, Abbott Vascular, and Edwards Lifesciences. Dr. Dawkins owns stock in Boston Scientific. All other authors have reported that they have no relevant relationships to the contents of this paper to disclose. David Moliterno, MD, served as Guest Editor for this paper.

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