Key result
PCI linked to ~60% fewer non-fatal periprocedural major adverse events than CABG.
Why the study?
The long-term prognostic impact of a composite of periprocedural major adverse events following revascularisation for patients with complex CAD had not been established.
Does the occurrence of non-fatal periprocedural major adverse events affect 10-year mortality in patients with complex CAD undergoing revascularization?
Cohort
Does the occurrence of non-fatal periprocedural major adverse events affect 10-year mortality in patients with complex CAD undergoing revascularization?
Absolute Event Rate: 11.2% vs 28.2%
p-value: p=<0.001
Non-fatal periprocedural major adverse events after revascularization for complex CAD predict mortality in the first year but not at 5 or 10 years, highlighting the need for careful early follow-up and optimal medical therapy.
Non-fatal periprocedural events may raise early mortality risk after complex CAD revascularization; observational data leaves open effects beyond 1 year.
BACKGROUND: The long-term prognostic impact of a composite of periprocedural major adverse events (PMAE) following revascularisation for patients with complex coronary artery disease (CAD) has not yet been established. AIMS: This study aimed to assess the impact on 10-year mortality of non-fatal PMAE following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Other objectives were to evaluate 1) whether PMAE affect mortality predicted by the SYNTAX score II 2020 (SSII-2020) and 2) whether optimal medical therapy (OMT) positively affects the prognosis of patients with non-fatal PMAE. METHODS: The association between 10-year mortality and non-fatal PMAE occurring within 30 days of PCI or CABG in patients with three-vessel disease and/or left main disease enrolled in the SYNTAXES study was investigated. RESULTS: The main findings are that non-fatal PMAE occurred less frequently following PCI than CABG (11.2% vs 28.2%; p<0.001) and that non-fatal PMAE were an independent predictor of all-cause mortality in the first year post-procedure, but not at 5 or 10 years, in both treatment modalities. PMAE substantially alter the individual predictions of 10-year mortality by the SSII-2020. In patients with non-fatal PMAE, OMT may provide survival benefits during the first year post-procedure as well as in the long term. CONCLUSIONS: In patients with complex CAD, non-fatal PMAE were more common following CABG than PCI, but their prognostic impact was similar, being significant in the first year and then diminishing out to 10 years. Patients with non-fatal PMAE may therefore require more careful follow-up and additional preventive treatment in the first year post-procedure.
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Kotoku et al. (2023) conducted a cohort in Complex coronary artery disease (three-vessel and/or left main disease). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass grafting (CABG) was evaluated on Non-fatal periprocedural major adverse events (PMAE) within 30 days (p=<0.001). Non-fatal periprocedural major adverse events occurred less frequently following PCI than CABG (11.2% vs 28.2%; p<0.001) and independently predicted all-cause mortality in the first year.
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