Impact of periprocedural major adverse events on 10-year mortality after revascularisation

DOI: 10.4244/EIJ-D-22-00681

Nozomi Kotoku
Nozomi Kotoku1, MD; Patrick W. Serruys1,2, MD, PhD; Kai Ninomiya1, MD; Alan Soo3, MD; Shinichiro Masuda1, MD; Shigetaka Kageyama1, MD; Pruthvi C. Revaiah1, MD; Michael J. Mack4, MD, PhD; David R Holmes5, MD; Marie-Claude Morice6, MD; Piroze M. Davierwala7,8,9, MD; Friedrich W. Mohr7, MD, PhD; Milan Milojevic10,11, MD, PhD; Arie Pieter Kappetein10, MD, PhD; Scot Garg12, MD, PhD; Yoshinobu Onuma1, MD, PhD
1. Department of Cardiology, University of Galway, Galway, Ireland; 2. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 3. Department of Cardiothoracic Surgery, University Hospital Galway, Galway, Ireland; 4. Department of Cardiothoracic Surgery, Baylor Scott & White Health, Dallas, TX, USA; 5. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; 6. Unité de Cardiologie, Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France; 7. University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany; 8. Department of Surgery, University of Toronto, Toronto, ON, Canada; 9. Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada; 10. Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; 11. Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia; 12. Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK

Background: The long-term prognostic impact of a composite of periprocedural major adverse events (PMAE) following revascularisation for patients with complex coronary artery disease (CAD) has not yet been established.

Aims: This study aimed to assess the impact on 10-year mortality of non-fatal PMAE following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Other objectives were to evaluate 1) whether PMAE affect mortality predicted by the SYNTAX score II 2020 (SSII-2020) and 2) whether optimal medical therapy (OMT) positively affects the prognosis of patients with non-fatal PMAE.

Methods: The association between 10-year mortality and non-fatal PMAE occurring within 30 days of PCI or CABG in patients with three-vessel disease and/or left main disease enrolled in the SYNTAXES study was investigated.

Results: The main findings are that non-fatal PMAE occurred less frequently following PCI than CABG (11.2% vs 28.2%; p<0.001) and that non-fatal PMAE were an independent predictor of all-cause mortality in the first year post-procedure, but not at 5 or 10 years, in both treatment modalities. PMAE substantially alter the individual predictions of 10-year mortality by the SSII-2020. In patients with non-fatal PMAE, OMT may provide survival benefits during the first year post-procedure as well as in the long term.

Conclusions: In patients with complex CAD, non-fatal PMAE were more common following CABG than PCI, but their prognostic impact was similar, being significant in the first year and then diminishing out to 10 years. Patients with non-fatal PMAE may therefore require more careful follow-up and additional preventive treatment in the first year post-procedure.

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