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van Geuns, Robert-Jan

0000-0003-2943-5932

Mayo Clinic

Department of Cardiology, Radboud University, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, The Netherlands.

Citations 1

Single or multiple arterial bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel or left main coronary artery disease
Davierwala, Piroze , Gao, Chao , Thuijs, Daniel J.F.M. , Wang, Rutao , Hara, Hironori , Ono, Masafumi , Noack, Thilo , Garg, Scot , O’Leary, Neil , Milojevic, Milan , Morice, Marie‐Claude, Mack, Michael J. , Geuns, Robert‐Jan van , Holmes, David R. , Onuma, Yoshinobu , Mohr, Friedrich W., Investigators, for the SYNTAX Extended Survival, Kappetein, Arie Pieter , van Geuns, Robert-Jan , Holmes, David R , Gaudino, Mario , Taggart, David P , Serruys, Patrick W , Noack, Thilo , Garg, Scot , Onuma, Yoshinobu , Milojevic, Milan , Kappetein, A. Pieter , Gaudino, Mario , Serruys, Patrick W. , Investigators, for the SYNTAX Extended Survival

European Heart Journal | August 1, 2021 | Volume: 43 | Issue: 13 | Pages: 1334-1344

10.1093/eurheartj/ehab537 Get It

Abstract Aim The aim of this study was to compare long-term all-cause mortality between patients receiving percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using multiple (MAG) or single arterial grafting (SAG). Methods and results The current study is a post hoc analysis of the SYNTAX Extended Survival Study, which compared PCI with CABG in patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD) and evaluated survival with ≥10 years of follow-up. The primary endpoint was all-cause mortality at maximum follow-up (median 11.9 years) assessed in the as-treated population. Of the 1743 patients, 901 (51.7%) underwent PCI, 532 (30.5%) received SAG, and 310 (17.8%) had MAG. At maximum follow-up, all-cause death occurred in 305 (33.9%), 175 (32.9%), and 70 (22.6%) patients in the PCI, SAG, and MAG groups, respectively (P < 0.001). Multiple arterial grafting [adjusted hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.49–0.89], but not SAG (adjusted HR 0.83, 95% CI 0.67–1.03), was associated with significantly lower all-cause mortality compared with PCI. In patients with 3VD, both MAG (adjusted HR 0.55, 95% CI 0.37–0.81) and SAG (adjusted HR 0.68, 95% CI 0.50–0.91) were associated with significantly lower mortality than PCI, whereas in LMCAD patients, no significant differences between PCI and MAG (adjusted HR 0.90, 95% CI 0.56–1.46) or SAG (adjusted HR 1.11, 95% CI 0.81–1.53) were observed. In patients with revascularization of all three major myocardial territories, a positive correlation was observed between the number of myocardial territories receiving arterial grafts and survival (P trend = 0.003). Conclusion Our findings suggest that MAG might be the more desirable configuration for CABG to achieve lower long-term all-cause mortality than PCI in patients with 3VD and/or LMCAD. Trial registration Registered on clinicaltrial.gov. SYNTAXES: NCT03417050 (https://clinicaltrials.gov/ct2/show/NCT03417050); SYNTAX: NCT00114972 (https://www.clinicaltrials.gov/ct2/show/NCT00114972).