Mortality after multivessel revascularisation involving the proximal left anterior descending artery

Abstract

ObjectiveWe sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD).MethodsThis post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed.ResultsAmong 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, pinteraction=0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; pinteraction=0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality.ConclusionsAmong patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG.Trial registration numberSYNTAXES:NCT03417050; SYNTAX:NCT00114972.

Association among β2‐adrenergic receptor autoantibodies and proximal left anterior descending artery lesions in patients with initial ST‐segment elevation myocardial infarction

“… 8 The SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score was also significantly higher in the proximal LAD group than in the nonproximal LAD group. 7 These results indicated that ischemia caused by proximal LAD lesions put more myocardium at risk and lead to a worse prognosis. However, the SORT‐OUT II study found opposite results.…”

“…The TWENTE I‐III study also found that the rate of the device‐oriented composite clinical endpoint (cardiac death, target vessel myocardial infarction, or target lesion revascularization) was higher in proximal LAD lesions 8 . The SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score was also significantly higher in the proximal LAD group than in the nonproximal LAD group 7 . These results indicated that ischemia caused by proximal LAD lesions put more myocardium at risk and lead to a worse prognosis.…”

“…The PROTECT (Patient Related Outcomes with Endeavor vs. Cypher Stenting Trial) study showed that proximal LAD lesions were associated with a higher incidence of myocardial infarction during long‐term follow‐up 5 . The study showed that the proximal LAD group had a higher incidence of major adverse cardiovascular events and all‐cause mortality than the nonproximal LAD group 6,7 . The TWENTE I‐III study also found that the rate of the device‐oriented composite clinical endpoint (cardiac death, target vessel myocardial infarction, or target lesion revascularization) was higher in proximal LAD lesions 8 .…”

“…5 The study showed that the proximal LAD group had a higher incidence of major adverse cardiovascular events and all-cause mortality than the nonproximal LAD group. 6,7 The TWENTE I-III study also found that the rate of the device-oriented composite clinical endpoint (cardiac death, target vessel myocardial infarction, or target lesion revascularization) was higher in proximal LAD lesions. 8 The SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score was also significantly higher in the proximal LAD group than in the nonproximal LAD group.…”