The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Major Infections after Bypass Surgery and Stenting for Multivessel Coronary Disease: An analysis of the randomized SYNTAX trial

DOI: 10.4244/EIJ-D-19-00208

1. Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy; Erasmus University Medical Center, Rotterdam, The Netherlands
2. Erasmus University Medical Center, Rotterdam, The Netherlands; Boston Scientific Corporation, Marlborough, MA, USA
3. Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Internal Medicine, University of Campinas, UNICAMP, Campinas, Brazil
4. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
5. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, and IRCCS Neuromed, Pozzili, Italy
6. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, and IRCCS Neuromed, Pozzili, Italy
7. Erasmus University Medical Center, Rotterdam, The Netherlands; Cardialysis B.V., Rotterdam, The Netherlands
8. Bristol Royal Infirmary, Bristol, United Kingdom
9. Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
10. Erasmus University Medical Center, Rotterdam, The Netherlands; Cardialysis B.V., Rotterdam, The Netherlands
11. Erasmus University Medical Center, Rotterdam, The Netherlands
12. Erasmus University Medical Center, Rotterdam, The Netherlands
13. Imperial College London, London, United Kingdom, UNITED KINGDOM
14. Institut Hospitalier Jacques Cartier, Generale de Sante, Massy, France
15. Mayo Clinic Rochester, Rochester, MN, USA
16. Hospital Israelita Albert Einstein, Sao Paulo, Brazil
17. Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
18. Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
19. Cardialysis B.V., Rotterdam, The Netherlands
20. Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
21. Erasmus University Medical Center, Rotterdam, The Netherlands
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Aims: Incidence, associated risk factors and impact on mortality of infections after bypass surgery (CABG) and stenting (PCI) for multivessel coronary disease (MVD) have never been reported in a large randomized trial. The aim of the present study is to evaluate, in patients with MVD, the prevalence of major infections after PCI and CABG and assess their impact on mortality. 

Methods and results: The SYNTAX trial randomized 1800 MVD patients to either CABG or PCI. Patients were followed up to 5 years. The primary endpoint of this post-hoc analysis was the occurrence of major infection. At 5 years of follow-up, the primary endpoint occurred in 142 (15.8%) patients in the CABG arm and 44 (4.9%) patients in the PCI arm (≤ 60 days– HR 7.9, 95% CI 4.7 to 13.1; p<0.001) (> 60 days– HR 0.79, 95% CI 0.44 to 1.44; p=0.45). Major infections were independently associated with a higher risk of all-cause mortality at 5 years (adjusted HR 2.6, 95% CI 1.8 to 3.8, p<0.001). 

Conclusions: CABG is associated with a higher incidence of post-procedure major infections compared to PCI. Major infections are independently associated with all-cause mortality.

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