Dr. Patrick W Serruys is currently a professor of cardiology at Imperial College's National Heart and Lung Institute (NHLI) at London's Cardiovascular Science Division (UK). He is currently a professor of cardiology at Imperial College's National Heart and Lung Institute (NHLI) at London's Cardiovascular Science Division (UK). In this podcast Dr. Serruys speaks on 10-Year All-Cause Mortality Following Percutaneous or Surgical Revascularization in Patients With Heavy Calcification.
Link to Abstract-
The goal of this study was to look at all-cause mortality after percutaneous coronary intervention (PCI) or coronary artery bypass grafting in individuals with substantially calcified lesions (HCLs) (CABG).
There is a scarcity of data on the long-term results of patients with HCLs based on the mode of revascularization.
The presence of HCLs within lesions with >50 percent diameter stenosis identified during the calculation of the anatomical SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score was assessed in this substudy of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study among 1,800 patients with 3-vessel disease and/or left main disease randomized to PCI or CABG Patients with HCLs were further classified and treated based on their illness type (3-vessel disease or left main disease) (PCI or CABG).
At ten years, the 532 patients with 1 HCL had a higher crude death rate (36.4 percent vs 22.3 percent; HR: 1.79; 95 percent CI: 1.49-2.16; P 0.001). An HCL was still an independent predictor of 10-year death after adjustment (HR: 1.36; 95 percent CI: 1.09-1.69; P = 0.006). Treatment impact (PCI and CABG) and the presence or absence of HCLs had a significant interaction in mortality (Pinteraction = 0.005). Mortality was considerably higher following PCI than after CABG in patients without HCLs (26.0 percent vs 18.8 percent; HR: 1.44; 95 percent CI: 0.97-1.41; P = 0.003), but not in those with HCLs (34.0 percent vs 39.0 percent; HR: 0.85; 95 percent CI: 0.64-1.13; P = 0.264).
The existence of an HCL was an independent predictor of mortality after ten years, with a similar prognosis after PCI or CABG. Beyond their existing contribution to the anatomical SYNTAX score, whether HCLs require special attention when determining the modality of revascularization warrants more investigation. (SYNTAX Extended Survival [SYNTAXES], NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX], NCT00114972; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SY