CABG better than PCI in CAD patients with good physical, mental health: Circulation
Ireland: A recent study in Circulation journal has reported that with CABG surgery, patients having multivessel or left main coronary artery disease (CAD) with the best physical and mental health had better 10-year survival compared with PCI.
The analysis of the SYNTAX Extended Survival (SYNTAXES) showed a strong association between patient-reported preprocedural physical and mental health status and long-term mortality and modified the relative treatment effects of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG).
In patients with complex CAD such as left-main CAD or 3-vessel disease, clinical and anatomical characteristics are considered key factors for deciding between PCI or CABG. However, not much is known about the interaction between self-reported preprocedural physical/mental health and clinical outcomes after revascularization.
Against the above background, Patrick W. Serruys, National University of Ireland, Galway, University Road, Galway, Ireland, and colleagues performed a subgroup analysis of the SYNTAXES trial, which is the extended follow-up of the randomized SYNTAX trial (Synergy Between PCI With Taxus and Cardiac Surgery) comparing PCI with CABG in patients with left-main CAD or 3-vessel disease.
The patients were stratified by Physical (PCS) or Mental Component Summary (MCS) scores derived from the preprocedural 36-Item Short Form Health Survey, with higher PCS and MCS scores representing better physical and mental health, respectively. All-cause death at 10 years was the primary endpoint.
Based on the study, the researchers reported the following findings:
· A total of 1656 patients with preprocedural 36-Item Short Form Health Survey data were included in the present study.
· Both higher PCS and MCS were independently associated with lower 10-year mortality (10-point increase in PCS adjusted hazard ratio, 0.84; in MCS adjusted hazard ratio, 0.85).
· A significant survival benefit with CABG over PCI was observed in the highest PCS (>45.5) and MCS (>52.3) terciles with significant treatment-by-subgroup interactions.
· In patients with both high PCS (>45.5) and MCS (>52.3), 10-year mortality was significantly higher with PCI compared with CABG (30.5% versus 12.2%; hazard ratio, 2.87), whereas among those with low PCS (≤45.5) or low MCS (≤52.3), there were no significant differences in 10-year mortality between PCI and CABG, resulting in a significant treatment-by-subgroup interaction.
"Patient-reported preprocedural physical and mental health status was strongly associated with long-term mortality and modified the relative treatment effects of PCI versus CABG among patients with left-main CAD or 3-vessel disease," the authors wrote. "Patients with the best physical and mental health had better 10-year survival with CABG compared with PCI."
"When selecting the optimal revascularization strategy, assessment of self-reported physical and mental health is important," they concluded.
Reference:
Ono M, Serruys PW, Garg S, et al. Effect of patient-reported preprocedural physical and mental health on 10-year mortality after percutaneous or surgical revascularization. Circulation. 2022;Epub ahead of print.
