TY - JOUR
T1 - Impact of preprocedural biological markers on 10-year mortality in the SYNTAXES trial
AU - Hara, Hironori
AU - Kawashima, Hideyuki
AU - Ono, Masafumi
AU - Takahashi, Kuniaki
AU - Mack, Michael J.
AU - Holmes, David R.
AU - Morice, Marie-Claude
AU - Davierwala, Piroze M.
AU - Mohr, Friedrich W.
AU - Thuijs, Daniel J. F. M.
AU - Kappetein, Arie Pieter
AU - O'Leary, Neil
AU - van Klaveren, David
AU - Onuma, Yoshinobu
AU - Serruys, Patrick W.
N1 - Funding Information: The SYNTAX Extended Survival study, which extended the follow-up up to 10 years, was supported by the German Foundation of Heart Research (Frankfurt am Main, Germany). The SYNTAX trial, covering the 0-5 year follow-up, was funded by Boston Scientific (Marlborough, MA, USA). Funding Information: H. Hara reports a grant for studying overseas from the Japanese Circulation Society and a grant from the Fukada Foundation for Medical Technology. M.C. Morice is CEO and shareholder of CERC, a CRO not involved in this trial, and is a minor shareholder of ELECTRODUCER. A. Kappetein reports working as an employee of Medtronic, outside the submitted work. P.W. Serruys reports personal fees from Biosensors, Micel Technologies, Sinomedical Sciences Technology, Philips/Volcano, Xeltis, HeartFlow, and SMT outside the submitted work. The other authors have no conflicts of interest to declare. Publisher Copyright: © Europa Digital & Publishing 2022. All rights reserved.
PY - 2022/4/22
Y1 - 2022/4/22
N2 - 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.
AB - 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.
KW - left main
KW - multiple vessel disease
KW - risk stratification
UR - http://www.scopus.com/inward/record.url?scp=85128802204&partnerID=8YFLogxK
U2 - https://doi.org/10.4244/EIJ-D-21-00415
DO - https://doi.org/10.4244/EIJ-D-21-00415
M3 - Article
C2 - 34669586
SN - 1774-024X
VL - 17
SP - 1477
EP - 1487
JO - Eurointervention
JF - Eurointervention
IS - 18
ER -