[en] OBJECTIVES: The very long-term mortality of off-pump and on-pump coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in a randomized complex coronary artery disease population is unknown. This study aims to investigate the impact of on-pump and off-pump CABG versus PCI on 10-year all-cause mortality. METHODS: The SYNTAX trial randomized 1800 patients with three-vessel and/or left main coronary artery disease to PCI or CABG and assessed their survival at 10 years. In this sub-study, the hazard of mortality over 10 years was compared according to the technique of revascularization: on-pump CABG (n = 725), off-pump CABG (n = 128) and PCI (n = 903). RESULTS: There was substantial inter-site variation in the use of off-pump CABG despite baseline characteristics being largely homogeneous among the 3 groups. The crude rate of mortality was significantly lower following on-pump CABG versus PCI [25.6% vs 28.4%, hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.65-0.96], while it was comparable between off-pump CABG and PCI (28.5% vs 28.4%, HR 0.98, 95% CI 0.69-1.40). After adjusting for the 9 variables included in the SYNTAX score II 2020, 10-year mortality remained significantly lower with on-pump CABG than PCI (HR 0.75 against PCI, P = 0.009). CONCLUSIONS: In the SYNTAXES trial, 10-year mortality adjusted for major confounders was significantly lower following on-pump CABG compared to PCI. There was no evidence for unadjusted difference between off-pump CABG and PCI, although the unadjusted estimated HR had a wide CI. Site heterogeneity in the technique used in bypass surgery has had measurable effects on treatment performance.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Kageyama, Shigetaka ; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.
Serruys, Patrick W ; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland. ; National Heart and Lung Institute, Imperial College London, London, UK.
Ninomiya, Kai; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.
O'Leary, Neil; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.
Masuda, Shinichiro; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.
Kotoku, Nozomi; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.
Colombo, Antonio; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. ; Humanitas Clinical and Research Centre IRCCS, Milan, Italy.
van Geuns, Robert-Jan; Department of Cardiology, Radboud University Medical Centre, Nijmegen, Netherlands.
Milojevic, Milan ; Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands. ; Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia.
Mack, Michael J; Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, TX, USA.
Soo, Alan; Department of Cardiothoracic Surgery, University Hospital Galway, Galway, Ireland.
Garg, Scot ; Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK.
Onuma, Yoshinobu; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.
Davierwala, Piroze M; Department of Surgery, University of Toronto, Toronto, ON, Canada. ; Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada. ; University Health Network, Toronto, ON, Canada.
Kolh, Philippe ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Biochimie et physiologie générales, humaines et pathologiques
LEGRAND, Victor ; Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie
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