SYNTAX Analysis: MI-Related Deaths More Common With PCI vs. CABG
Although 5-year all-cause mortality rates are similar in patients with complex CAD whether they undergo either CABG or PCI, deaths related to MI are less frequent with CABG, according to an analysis of the SYNTAX trial presented at TCT 2015.
Milan Milojevic, MD, MSc, of Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues conducted a review of patients in the randomized cohort and nested registries of the SYNTAX trial to determine specific causes of death. The randomized cohort included 897 CABG and 903 PCI patients with de novo left main disease and/or three-vessel disease. Deaths were classified as cardiovascular (cardiac and vascular), noncardiovascular and undetermined.
Through 5 years of follow-up, there were 123 and 97 deaths in the randomized PCI and CABG groups, respectively. In the PCI patients, 67.5% of deaths were cardiovascular and 29.3% were the result of MI. In the CABG patients, 49.4% of deaths were cardiovascular, with the most common cause being a combination of heart failure, arrhythmia or other causes (24.6%).
Analysis of the randomized cohort showed no difference between the PCI and CABG groups in all-cause mortality, although disparities emerged when looking at specific causes of death (see Table).
The difference in MI-related death was most evident in patients with diabetes, three-vessel disease or SYNTAX scores of 33 or higher.
Several baseline, procedural and postprocedural variables independently predicted both all-cause and cardiac death. These included discharge medication use and adverse events during follow-up.
Five-year mortality outcomes “for the nested registries were similar, although the death rate in the PCI registry was higher and more often the result of noncardiovascular causes,” the abstract reports.
“Our results tell clinicians that PCI is an attractive treatment option for patients with left main disease or less complex lesions, but treatments should target reducing postrevascularization spontaneous MI, since this remains the leading cause of death after PCI,” Milojevic told TCT Daily. “Prevention of MI after treatment with PCI is therefore of critical importance for survival. As shown in our analyses, as well as in several other studies, the importance of secondary prevention medication is essential in this regard.”
- Milojevic reports no relevant conflicts of interest.