Coronary interventions - Mini focus on left main revascularisation

Impact of preprocedural biological markers on 10-year mortality in the SYNTAXES trial

EuroIntervention 2022;17:1477-1487. DOI: 10.4244/EIJ-D-21-00415

Hironori Hara
Hironori Hara1,2, MD; Hideyuki Kawashima1,2, MD; Masafumi Ono1,2, MD; Kuniaki Takahashi1, MD; Michael J. Mack3, MD; David R. Holmes Jr4, MD; Marie-Claude Morice5, MD; Piroze M. Davierwala6, MD; Friedrich W. Mohr6, MD, PhD; Daniel J.F.M. Thuijs7, MD; Arie Pieter Kappetein2, MD, PhD; Neil O'Leary8, PhD; David van Klaveren9,10, PhD; Yoshinobu Onuma2, MD, PhD; Patrick W. Serruys2,11, MD, PhD
1. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 2. Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; 3. Department of Cardiothoracic Surgery, Baylor Scott & White Health, Dallas, TX, USA; 4. Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA; 5. Unité de Cardiologie, Hôpital Privé Jacques Cartier, Générale de Santé Massy, Massy, France; 6. University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany; 7. Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; 8. Health Research Board Clinical Research Facility, Department of Medicine, NUIG, Galway, Ireland; 9. Department of Public Health, Center for Medical Decision Making, Erasmus MC, Rotterdam, the Netherlands; 10. Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; 11. NHLI, Imperial College London, London, United Kingdom

Background: Creatinine clearance (CrCl) is an independent determinant of mortality in predictive models of revascularisation outcomes for complex coronary artery disease.

Aims: This study aimed to investigate the impact of preprocedural biological markers on 10-year mortality following coronary revascularisation.

Methods: The SYNTAX Extended Survival (SYNTAXES) study evaluated the 10-year vital status follow-up of 1,800 patients with de novo three-vessel (3VD) and/or left main coronary artery disease (LMCAD) randomised to include percutaneous or surgical coronary revascularisation. The associations between mortality and preprocedural C-reactive protein (CRP), haemoglobin, HbA1c, CrCl, fasting triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were analysed.

Results: Out of 1,800 patients, 460 patients died before the 10-year follow-up. CRP, HbA1c and CrCl with threshold values of ≥2 mg/L, ≥6% (42 mmol/mol) and <60 ml/min, respectively, were associated with 10-year all-cause death (adjusted hazard ratio [95% confidence interval]: 1.35 [1.01-1.82], 1.51 [1.16-1.95], and 1.46 [1.07-2.00], respectively). There was no significant interaction between the biological markers on all-cause mortality and the type of revascularisation. Preprocedural lipid markers were not significantly associated with 10-year all-cause death, but the non-use of statins was a determinant factor of worse prognosis (adjusted hazard ratio [95% confidence interval]: 1.68 [1.26-2.25]).

Conclusions: Preprocedural biomarkers, such as CRP and HbA1c, are associated with long-term mortality post revascularisation, regardless of the revascularisation technique. Conventional lipidic biomarkers associated with high-risk of cardiovascular events seem to be effectively mitigated by the long-term use of statins, whereas the non-use of statins was a factor of a worse prognosis, emphasising the importance of pharmacological treatment. Trial registration: SYNTAXES ClinicalTrials.gov: NCT03417050. SYNTAX ClinicalTrials.gov: NCT00114972.

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