Coronary interventions

Major infections after bypass surgery and stenting for multivessel coronary disease in the randomised SYNTAX trial

EuroIntervention 2020;15:1520-1526. DOI: 10.4244/EIJ-D-19-00208

Massimo Mancone
Massimo Mancone1, MD; Rafael Cavalcante2,3, MD; Rodrigo Modolo4,5, MD; Marco Falcone6, MD; Giuseppe Biondi-Zoccai7,8, MD, MStat; Giacomo Frati9,8, MD; Ernest Spitzer2,10, MD; Umberto Benedetto11, MD; Eugene H. Blackstone12, MD; Yoshinobu Onuma2, MD, PhD; Robert-Jan M. van Geuns2, MD; Roberto Diletti2, MD; Patrick W. Serruys13,14
1. Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy; 2. Erasmus University Medical Center, Rotterdam, the Netherlands; 3. Boston Scientific Corporation, Marlborough, MA, USA; 4. Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands; 5. Department of Internal Medicine, University of Campinas, UNICAMP, Campinas, Brazil; 6. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 7. Mediterranea Cardiocentro, Naples, Italy; 8. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; 9. IRCCS Neuromed, Pozzilli, Italy; 10. Cardialysis B.V., Rotterdam, the Netherlands; 11. Bristol Royal Infirmary, Bristol, United Kingdom; 12. Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA; 13. Imperial College London, London, United Kingdom; 14. Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland

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 randomised trial. The aim of the present study was to evaluate, in patients with MVD, the prevalence of major infections after PCI and CABG and to assess their impact on mortality.

Methods and results: The SYNTAX trial randomised 1,800 MVD patients to either CABG or PCI. Patients were followed up to five years. The primary endpoint of this post hoc analysis was the occurrence of major infection. At five years of follow-up, the primary endpoint had 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 five 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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deathleft mainmultiple vessel disease
Coronary interventionsLeft main and multivessel disease
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