Author + information
- Received July 28, 2015
- Revision received October 6, 2015
- Accepted October 8, 2015
- Published online January 5, 2016.
- Milan Milojevic, MD, MSc∗,
- Stuart J. Head, MD, PhD∗,
- Catalina A. Parasca, MD∗,
- Patrick W. Serruys, MD, PhD†,
- Friedrich W. Mohr, MD, PhD‡,
- Marie-Claude Morice, MD§,
- Michael J. Mack, MD‖,
- Elisabeth Ståhle, MD¶,
- Ted E. Feldman, MD#,
- Keith D. Dawkins, MD∗∗,
- Antonio Colombo, MD††,
- A. Pieter Kappetein, MD, PhD∗ and
- David R. Holmes Jr., MD‡‡∗ ()
- ∗Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
- †Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- ‡Department of Cardiovascular Surgery, Herzzentrum Universität Leipzig, Leipzig, Germany
- §Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
- ‖Department of Cardiovascular Surgery, Heart Hospital Baylor Plano, Baylor Healthcare System, Plano, Texas
- ¶Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden
- #Cardiology Division, Evanston Hospital, Evanston, Illinois
- ∗∗Boston Scientific Corporation, Natick, Massachusetts
- ††Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- ‡‡Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
- ↵∗Reprint requests and correspondence:
Prof. David R. Holmes, Jr., Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota 55905.
Background There are no data available on specific causes of death from randomized trials that have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI).
Objectives The purpose of this study was to investigate specific causes of death, and its predictors, after revascularization for complex coronary disease in patients.
Methods An independent Clinical Events Committee consisting of expert physicians who were blinded to the study treatment subclassified causes of death as cardiovascular (cardiac and vascular), noncardiovascular, or undetermined according to the trial protocol. Cardiac deaths were classified as sudden cardiac, related to myocardial infarction (MI), and other cardiac deaths.
Results In the randomized cohort, there were 97 deaths after CABG and 123 deaths after PCI during a 5-year follow-up. After CABG, 49.4% of deaths were cardiovascular, with the greatest cause being heart failure, arrhythmia, or other causes (24.6%), whereas after PCI, the majority of deaths were cardiovascular (67.5%) and as a result of MI (29.3%). The cumulative incidence rates of all-cause death were not significantly different between CABG and PCI (11.4% vs. 13.9%, respectively; p = 0.10), whereas there were significant differences in terms of cardiovascular (5.8% vs. 9.6%, respectively; p = 0.008) and cardiac death (5.3% vs. 9.0%, respectively; p = 0.003), which were caused primarily by a reduction in MI-related death with CABG compared with PCI (0.4% vs. 4.1%, respectively; p <0.0001). Treatment with PCI versus CABG was an independent predictor of cardiac death (hazard ratio: 1.55; 95% confidence interval: 1.09 to 2.33; p = 0.045). The difference in MI-related death was seen largely in patients with diabetes, 3-vessel disease, or high SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries) trial scores.
Conclusions During a 5-year follow-up, CABG in comparison with PCI was associated with a significantly reduced rate of MI-related death, which was the leading cause of death after PCI. Treatments following PCI should target reducing post-revascularization spontaneous MI. Furthermore, secondary preventive medication remains essential in reducing events post-revascularization. (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972)
- cardiac death
- cause of death
- coronary artery bypass grafting
- heart failure
- myocardial infarction
- percutaneous coronary intervention
- sudden death
This study was supported by Boston Scientific. Dr. Feldman has received consulting and lecture fees, and research support from Boston Scientific, Abbott Vascular, and Edwards Lifesciences. Dr. Dawkins owns stock in Boston Scientific. All other authors have reported that they have no relevant relationships to the contents of this paper to disclose. David Moliterno, MD, served as Guest Editor for this paper.
- Received July 28, 2015.
- Revision received October 6, 2015.
- Accepted October 8, 2015.
- American College of Cardiology Foundation