[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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Bibliography
Gaudino M, Angelini GD, Antoniades C, Bakaeen F, Benedetto U, Calafiore AM et al. Off-pump coronary artery bypass grafting: 30 years of debate. J Am Heart Assoc 2018;7:e009934.
Deppe AC, Arbash W, Kuhn EW, Slottosch I, Scherner M, Liakopoulos OJ et al. Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of over 16 900 patients investigated in randomized controlled trials. Eur J Cardiothorac Surg 2016;49:1031–41; discussion 1041.
Gaudino M, Benedetto U, Bakaeen F, Rahouma M, Tam DY, Abouarab A et al. Off- versus on-pump coronary surgery and the effect of follow-up length and surgeons’ experience: a meta-analysis. J Am Heart Assoc 2018;7:e010034.
Shroyer AL, Hattler B, Wagner TH, Collins JF, Baltz JH, Quin JA et al.; Veterans Affairs ROOBY-FS Group. Five-year outcomes after on-pump and off-pump coronary-artery bypass. New Engl J Med 2017;377: 623–32.
Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu SS, Straka Z et al.; CORONARY Investigators. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. New Engl J Med 2016;375: 2359–68.
Benedetto U, Caputo M, Patel NN, Fiorentino F, Bryan A, Angelini GD. Long-term survival after off-pump versus on-pump coronary artery bypass graft surgery. Does completeness of revascularization play a role? Int J Cardiol 2017;246:32–6.
Farkouh ME, Domanski M, Dangas GD, Godoy LC, Mack MJ, Siami FS et al.; FREEDOM Follow-On Study Investigators. Long-term survival following multivessel revascularization in patients with diabetes: the FREEDOM follow-on study. J Am Coll Cardiol 2019;73:629–38.
Park SJ, Ahn JM, Kim YH, Park DW, Yun SC, Lee JY et al.; BEST Trial Investigators. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med 2015;372:1204–12.
Thuijs DJFM, Kappetein AP, Serruys PW, Mohr FW, Morice MC, Mack MJ et al.; SYNTAX Extended Survival Investigators. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet 2019;394: 1325–34.
Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ et al.; SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. New Engl J Med 2009;360:961–72.
Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T et al.; Japanese Circulation Society Joint Working Group. JCS/JSCVS 2018 guideline on revascularization of stable coronary artery disease. Circ J 2022;86: 477–588.
Takahashi K, Serruys PW, Fuster V, Farkouh ME, Spertus JA, Cohen DJ et al.; SYNTAXES, FREEDOM, BEST, and PRECOMBAT trial investigators. Redevelopment and validation of the SYNTAX score II to individualise decision-making between percutaneous and surgical revascularisation in patients with complex coronary artery disease: secondary analysis of the multicentre randomised controlled SYNTAXES trial with external cohort validation. Lancet 2020;396:1399–412.
Hara H, Shiomi H, van Klaveren D, Kent DM, Steyerberg EW, Garg S et al. External validation of the SYNTAX score II 2020. J Am Coll Cardiol 2021;78:1227–38.
Kageyama S, Serruys PW, Garg S, Ninomiya K, Masuda S, Kotoku N et al.; SYNTAX Extended Survival Investigators. Geographic disparity in 10-year mortality after coronary artery revascularization in the SYNTAXES trial. Int J Cardiol 2022;368:28–38.
Ono M, Serruys PW, Garg S, Kawashima H, Gao C, Hara H et al.; for the SYNTAX Extended Survival Investigators. Effect of patient-reported preprocedural physical and mental health on 10-year mortality after percutaneous or surgical coronary revascularization. Circulation 2022;146: 1268–80.
Taggart DP, Benedetto U, Gerry S, Altman DG, Gray AM, Lees B et al.; Arterial Revascularization Trial Investigators. Bilateral versus single internal-thoracic-artery grafts at 10 years. N Engl J Med 2019;380: 437–46.
Benedetto U, Puskas J, Kappetein AP, Brown WM 3rd, Horkay F, Boonstra PW et al. Off-pump versus on-pump bypass surgery for left main coronary artery disease. J Am Coll Cardiol 2019;74:729–40.
Quin JA, Wagner TH, Hattler B, Carr BM, Collins J, Almassi GH et al. Ten-year outcomes of off-pump vs on-pump coronary artery bypass grafting in the department of veterans affairs: a randomized clinical trial. JAMA Surg 2022;157:303–10.
Stone GW, Kappetein AP, Sabik JF, Pocock SJ, Morice MC, Puskas J et al.; EXCEL Trial Investigators. Five-year outcomes after PCI or CABG for left main coronary disease. N Engl J Med 2019;381:1820–30.
Park DW, Ahn JM, Park H, Yun SC, Kang DY, Lee PH et al.; PRECOMBAT Investigators. Ten-year outcomes after drug-eluting stents versus coronary artery bypass grafting for left main coronary disease: extended follow-up of the PRECOMBAT trial. Circulation 2020;141:1437–46.
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