TY - JOUR
T1 - Impact of residual angina on long-term clinical outcomes after percutaneous coronary intervention or coronary artery bypass graft for complex coronary artery disease
AU - Ono, Masafumi
AU - Serruys, Patrick W.
AU - Kawashima, Hideyuki
AU - Lunardi, Mattia
AU - Wang, Rutao
AU - Hara, Hironori
AU - Gao, Chao
AU - Garg, Scot
AU - O'Leary, Neil
AU - Wykrzykowska, Joanna J.
AU - Piek, Jan J.
AU - Holmes, David R.
AU - Morice, Marie-Claude
AU - Kappetein, Arie Pieter
AU - Noack, Thilo
AU - Davierwala, Piroze M.
AU - Spertus, John A.
AU - SYNTAX Extended Survival Investigators
AU - Cohen, David J.
AU - Onuma, Yoshinobu
N1 - Funding Information: P.W.S. reports personal fees from Biosensors, Micel Technologies, Sinomedical Sciences Technology, Philips/Volcano, Xeltis, and HeartFlow, outside the submitted work. H.H. reports a grant for studying overseas from the Japanese Circulation Society and a grant from the Fukuda Foundation for Medical Technology, outside the submitted work. J.J.P. reports personal fees and non-financial support from Philips/Volcano, outside the submitted work. M.C.M. is the chief executive officer and shareholder of the European Center for Cardiovascular Research, outside the submitted work. A.P.K. report to work as an employee of Medtronic, outside the submitted work. J.A.S. reports grants from Abbott Vascular, outside the submitted work; in addition, J.A.S. has a patent copyright to the Seattle Angina Questionnaire with royalties paid. D.J.C. reports grants from Boston Scientific to Saint Luke's Mid America Heart Institute during the conduct of the study; grants and personal fees from Boston Scientific; grants and personal fees from Abbott; and grants and personal fees from Medtronic, outside the submitted work. All other authors have no conflict of interest to declare. Funding Information: The SYNTAX Extended Survival study, during extension of follow-up up to 10 years, was supported by the German Foundation of Heart Research (Frankfurt am Main, Germany). The SYNTAX trial, during 0–5 year follow-up, was funded by Boston Scientific Corporation (Marlborough, MA, USA). Publisher Copyright: © 2022 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - AIMS: The aim of this study was to investigate the impact on 10-year survival of patient-reported anginal status at 1 year following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD) and/or three-vessel CAD (3VD). METHODS AND RESULTS: In this post hoc analysis of the randomized SYNTAX Extended Survival study, patients were classified as having residual angina (RA) if their self-reported Seattle Angina Questionnaire angina frequency (SAQ-AF) scale was ≤90 at the 1-year follow-up post-revascularization with PCI or CABG. The primary endpoint of all-cause death at 10 years was compared between the RA and no-RA groups. A sensitivity analysis was performed using a 6-month SAQ-AF.At 1 year, 373 (26.1%) out of 1428 patients reported RA. Whilst RA at 1 year was an independent correlate of repeat revascularization at 5 years [18.3 vs. 11.5%; adjusted hazard ratio (HR): 1.54; 95% confidence interval (CI): 1.10-2.15], it was not associated with all-cause death at 10 years (22.1 vs. 21.6%; adjusted HR: 1.11; 95% CI: 0.83-1.47). These results were consistent when stratified by the modality of revascularization (PCI or CABG) or by anginal frequency. The sensitivity analysis replicating the analyses based on 6-month angina status resulted in similar findings. CONCLUSION: Among patients with LMCAD and/or 3VD, patient-reported RA at 1 year post-revascularization was independently associated with repeat revascularization at 5 years; however, it did not significantly increase 10-year mortality, irrespective of the primary modality of revascularization or severity of RA.
AB - AIMS: The aim of this study was to investigate the impact on 10-year survival of patient-reported anginal status at 1 year following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD) and/or three-vessel CAD (3VD). METHODS AND RESULTS: In this post hoc analysis of the randomized SYNTAX Extended Survival study, patients were classified as having residual angina (RA) if their self-reported Seattle Angina Questionnaire angina frequency (SAQ-AF) scale was ≤90 at the 1-year follow-up post-revascularization with PCI or CABG. The primary endpoint of all-cause death at 10 years was compared between the RA and no-RA groups. A sensitivity analysis was performed using a 6-month SAQ-AF.At 1 year, 373 (26.1%) out of 1428 patients reported RA. Whilst RA at 1 year was an independent correlate of repeat revascularization at 5 years [18.3 vs. 11.5%; adjusted hazard ratio (HR): 1.54; 95% confidence interval (CI): 1.10-2.15], it was not associated with all-cause death at 10 years (22.1 vs. 21.6%; adjusted HR: 1.11; 95% CI: 0.83-1.47). These results were consistent when stratified by the modality of revascularization (PCI or CABG) or by anginal frequency. The sensitivity analysis replicating the analyses based on 6-month angina status resulted in similar findings. CONCLUSION: Among patients with LMCAD and/or 3VD, patient-reported RA at 1 year post-revascularization was independently associated with repeat revascularization at 5 years; however, it did not significantly increase 10-year mortality, irrespective of the primary modality of revascularization or severity of RA.
KW - 10-year Survival
KW - Angina
KW - CABG
KW - Left-main coronary artery disease
KW - PCI
KW - Quality of life
KW - Revascularization
KW - SYNTAX
KW - Three-vessel disease
UR - http://www.scopus.com/inward/record.url?scp=85166735484&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/ehjqcco/qcac052
DO - https://doi.org/10.1093/ehjqcco/qcac052
M3 - Article
C2 - 36001991
SN - 2058-5225
VL - 9
SP - 490
EP - 501
JO - European Heart Journal - Quality of Care and Clinical Outcomes
JF - European Heart Journal - Quality of Care and Clinical Outcomes
IS - 5
ER -