10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease

SYNTAX Extended Survival Investig; Masafumi Ono; Patrick W. Serruys; Hironori Hara; Hideyuki Kawashima; Chao Gao; Rutao Wang; Kuniaki Takahashi; Neil O'Leary; Joanna J. Wykrzykowska; Faisal Sharif; Jan J. Piek; Scot Garg; Michael J. Mack; David R. Holmes; Marie-Claude Morice; Stuart J. Head; Arie Pieter Kappetein; Daniel J. F. M. Thuijs; Thilo Noack; Piroze M. Davierwala; Friedrich W. Mohr; David J. Cohen; Yoshinobu Onuma

doi:10.1016/j.jacc.2021.04.016

10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease

SYNTAX Extended Survival Investig, Masafumi Ono, Patrick W. Serruys^*, Hironori Hara, Hideyuki Kawashima, Chao Gao, Rutao Wang, Kuniaki Takahashi, Neil O'Leary, Joanna J. Wykrzykowska, Faisal Sharif, Jan J. Piek, Scot Garg, Michael J. Mack, David R. Holmes, Marie-Claude Morice, Stuart J. Head, Arie Pieter Kappetein, Daniel J. F. M. Thuijs, Thilo NoackPiroze M. Davierwala, Friedrich W. Mohr, David J. Cohen, Yoshinobu Onuma

^*Corresponding author for this work

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Abstract

BACKGROUND The optimal revascularization strategy for the elderly with complex coronary artery disease remains unclear.

OBJECTIVES The goal of this study was to investigate 10-year all-cause mortality, life expectancy, 5-year major adverse cardiac or cerebrovascular events (MACCE), and 5-year quality of life (QOL) after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in elderly individuals (>70 years old) with 3-vessel disease (3VD) and/or left main disease (LMD).

METHODS In the present pre-specified analysis on age of the SYNTAX Extended Survival study, 10-year all-cause death and 5-year MACCE were compared with Kaplan-Meier estimates and Cox proportional hazards models among elderly or nonelderly patients. Life expectancy was estimated by restricted mean survival time within 10 years, and QOL status according to the Seattle Angina Questionnaire up to 5 years was assessed by linear mixed-effects models.

RESULTS Among 1,800 randomized patients, 575 patients (31.9%) were elderly. Ten-year mortality did not differ significantly between PCI and CABG in elderly (44.1% vs. 41.1%; hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 0.84 to 1.40) and nonelderly patients (21.1% vs. 16.6%; HR: 1.30; 95% CI: 1.00 to 1.69; p(interaction) = 0.332). Among elderly patients, 5-year MACCE was comparable between PCI and CABG (39.4% vs. 35.1%; HR: 1.18; 95% CI: 0.90 to 1.56), whereas it was significantly higher in PCI over CABG among nonelderly patients (36.3% vs. 23.0%; HR: 1.69; 95% CI: 1.36 to 2.10; p(interaction) = 0.043). There were no significant difference in life expectancy (mean difference: 0.2 years in favor of CABG; 95% CI: -0.4 to 0.7) and 5-year QOL status between PCI and CABG among elderly patients.

CONCLUSIONS Elderly patients with 3VD and/or LMD had comparable 10-year all-cause death, life expectancy, 5-year MACCE, and 5-year QOL status irrespective of revascularization mode. (C) 2021 by the American College of Cardiology Foundation.

Original language	English
Pages (from-to)	2761-2773
Number of pages	13
Journal	Journal of the American College of Cardiology
Volume	77
Issue number	22
Early online date	31-May-2021
DOIs	https://doi.org/10.1016/j.jacc.2021.04.016
Publication status	Published - 8-Jun-2021

Keywords

CABG
elderly
life expectancy
long-term outcome
PCI
SYNTAX
BYPASS GRAFT-SURGERY
INTERVENTION
OUTCOMES
TRIAL
THERAPY

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10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery DiseaseFinal publisher's version, 1.35 MBLicence: Taverne

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SYNTAX Extended Survival Investig, Ono, M., Serruys, P. W., Hara, H., Kawashima, H., Gao, C., Wang, R., Takahashi, K., O'Leary, N., Wykrzykowska, J. J., Sharif, F., Piek, J. J., Garg, S., Mack, M. J., Holmes, D. R., Morice, M.-C., Head, S. J., Kappetein, A. P., Thuijs, D. J. F. M., ... Onuma, Y. (2021). 10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease. Journal of the American College of Cardiology, 77(22), 2761-2773. https://doi.org/10.1016/j.jacc.2021.04.016

@article{da9aa4c3cc084d5081746e10a3a2da0f,

title = "10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease",

abstract = "BACKGROUND The optimal revascularization strategy for the elderly with complex coronary artery disease remains unclear.OBJECTIVES The goal of this study was to investigate 10-year all-cause mortality, life expectancy, 5-year major adverse cardiac or cerebrovascular events (MACCE), and 5-year quality of life (QOL) after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in elderly individuals (>70 years old) with 3-vessel disease (3VD) and/or left main disease (LMD).METHODS In the present pre-specified analysis on age of the SYNTAX Extended Survival study, 10-year all-cause death and 5-year MACCE were compared with Kaplan-Meier estimates and Cox proportional hazards models among elderly or nonelderly patients. Life expectancy was estimated by restricted mean survival time within 10 years, and QOL status according to the Seattle Angina Questionnaire up to 5 years was assessed by linear mixed-effects models.RESULTS Among 1,800 randomized patients, 575 patients (31.9%) were elderly. Ten-year mortality did not differ significantly between PCI and CABG in elderly (44.1% vs. 41.1%; hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 0.84 to 1.40) and nonelderly patients (21.1% vs. 16.6%; HR: 1.30; 95% CI: 1.00 to 1.69; p(interaction) = 0.332). Among elderly patients, 5-year MACCE was comparable between PCI and CABG (39.4% vs. 35.1%; HR: 1.18; 95% CI: 0.90 to 1.56), whereas it was significantly higher in PCI over CABG among nonelderly patients (36.3% vs. 23.0%; HR: 1.69; 95% CI: 1.36 to 2.10; p(interaction) = 0.043). There were no significant difference in life expectancy (mean difference: 0.2 years in favor of CABG; 95% CI: -0.4 to 0.7) and 5-year QOL status between PCI and CABG among elderly patients.CONCLUSIONS Elderly patients with 3VD and/or LMD had comparable 10-year all-cause death, life expectancy, 5-year MACCE, and 5-year QOL status irrespective of revascularization mode. (C) 2021 by the American College of Cardiology Foundation.",

keywords = "CABG, elderly, life expectancy, long-term outcome, PCI, SYNTAX, BYPASS GRAFT-SURGERY, INTERVENTION, OUTCOMES, TRIAL, THERAPY",

author = "{SYNTAX Extended Survival Investig} and Masafumi Ono and Serruys, {Patrick W.} and Hironori Hara and Hideyuki Kawashima and Chao Gao and Rutao Wang and Kuniaki Takahashi and Neil O'Leary and Wykrzykowska, {Joanna J.} and Faisal Sharif and Piek, {Jan J.} and Scot Garg and Mack, {Michael J.} and Holmes, {David R.} and Marie-Claude Morice and Head, {Stuart J.} and Kappetein, {Arie Pieter} and Thuijs, {Daniel J. F. M.} and Thilo Noack and Davierwala, {Piroze M.} and Mohr, {Friedrich W.} and Cohen, {David J.} and Yoshinobu Onuma",

year = "2021",

month = jun,

day = "8",

doi = "10.1016/j.jacc.2021.04.016",

language = "English",

volume = "77",

pages = "2761--2773",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "ELSEVIER SCIENCE INC",

number = "22",

}

SYNTAX Extended Survival Investig, Ono, M, Serruys, PW, Hara, H, Kawashima, H, Gao, C, Wang, R, Takahashi, K, O'Leary, N, Wykrzykowska, JJ, Sharif, F, Piek, JJ, Garg, S, Mack, MJ, Holmes, DR, Morice, M-C, Head, SJ, Kappetein, AP, Thuijs, DJFM, Noack, T, Davierwala, PM, Mohr, FW, Cohen, DJ & Onuma, Y 2021, '10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease', Journal of the American College of Cardiology, vol. 77, no. 22, pp. 2761-2773. https://doi.org/10.1016/j.jacc.2021.04.016

TY - JOUR

T1 - 10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease

AU - SYNTAX Extended Survival Investig

AU - Ono, Masafumi

AU - Serruys, Patrick W.

AU - Hara, Hironori

AU - Kawashima, Hideyuki

AU - Gao, Chao

AU - Wang, Rutao

AU - Takahashi, Kuniaki

AU - O'Leary, Neil

AU - Wykrzykowska, Joanna J.

AU - Sharif, Faisal

AU - Piek, Jan J.

AU - Garg, Scot

AU - Mack, Michael J.

AU - Holmes, David R.

AU - Morice, Marie-Claude

AU - Head, Stuart J.

AU - Kappetein, Arie Pieter

AU - Thuijs, Daniel J. F. M.

AU - Noack, Thilo

AU - Davierwala, Piroze M.

AU - Mohr, Friedrich W.

AU - Cohen, David J.

AU - Onuma, Yoshinobu

PY - 2021/6/8

Y1 - 2021/6/8

N2 - BACKGROUND The optimal revascularization strategy for the elderly with complex coronary artery disease remains unclear.OBJECTIVES The goal of this study was to investigate 10-year all-cause mortality, life expectancy, 5-year major adverse cardiac or cerebrovascular events (MACCE), and 5-year quality of life (QOL) after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in elderly individuals (>70 years old) with 3-vessel disease (3VD) and/or left main disease (LMD).METHODS In the present pre-specified analysis on age of the SYNTAX Extended Survival study, 10-year all-cause death and 5-year MACCE were compared with Kaplan-Meier estimates and Cox proportional hazards models among elderly or nonelderly patients. Life expectancy was estimated by restricted mean survival time within 10 years, and QOL status according to the Seattle Angina Questionnaire up to 5 years was assessed by linear mixed-effects models.RESULTS Among 1,800 randomized patients, 575 patients (31.9%) were elderly. Ten-year mortality did not differ significantly between PCI and CABG in elderly (44.1% vs. 41.1%; hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 0.84 to 1.40) and nonelderly patients (21.1% vs. 16.6%; HR: 1.30; 95% CI: 1.00 to 1.69; p(interaction) = 0.332). Among elderly patients, 5-year MACCE was comparable between PCI and CABG (39.4% vs. 35.1%; HR: 1.18; 95% CI: 0.90 to 1.56), whereas it was significantly higher in PCI over CABG among nonelderly patients (36.3% vs. 23.0%; HR: 1.69; 95% CI: 1.36 to 2.10; p(interaction) = 0.043). There were no significant difference in life expectancy (mean difference: 0.2 years in favor of CABG; 95% CI: -0.4 to 0.7) and 5-year QOL status between PCI and CABG among elderly patients.CONCLUSIONS Elderly patients with 3VD and/or LMD had comparable 10-year all-cause death, life expectancy, 5-year MACCE, and 5-year QOL status irrespective of revascularization mode. (C) 2021 by the American College of Cardiology Foundation.

AB - BACKGROUND The optimal revascularization strategy for the elderly with complex coronary artery disease remains unclear.OBJECTIVES The goal of this study was to investigate 10-year all-cause mortality, life expectancy, 5-year major adverse cardiac or cerebrovascular events (MACCE), and 5-year quality of life (QOL) after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in elderly individuals (>70 years old) with 3-vessel disease (3VD) and/or left main disease (LMD).METHODS In the present pre-specified analysis on age of the SYNTAX Extended Survival study, 10-year all-cause death and 5-year MACCE were compared with Kaplan-Meier estimates and Cox proportional hazards models among elderly or nonelderly patients. Life expectancy was estimated by restricted mean survival time within 10 years, and QOL status according to the Seattle Angina Questionnaire up to 5 years was assessed by linear mixed-effects models.RESULTS Among 1,800 randomized patients, 575 patients (31.9%) were elderly. Ten-year mortality did not differ significantly between PCI and CABG in elderly (44.1% vs. 41.1%; hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 0.84 to 1.40) and nonelderly patients (21.1% vs. 16.6%; HR: 1.30; 95% CI: 1.00 to 1.69; p(interaction) = 0.332). Among elderly patients, 5-year MACCE was comparable between PCI and CABG (39.4% vs. 35.1%; HR: 1.18; 95% CI: 0.90 to 1.56), whereas it was significantly higher in PCI over CABG among nonelderly patients (36.3% vs. 23.0%; HR: 1.69; 95% CI: 1.36 to 2.10; p(interaction) = 0.043). There were no significant difference in life expectancy (mean difference: 0.2 years in favor of CABG; 95% CI: -0.4 to 0.7) and 5-year QOL status between PCI and CABG among elderly patients.CONCLUSIONS Elderly patients with 3VD and/or LMD had comparable 10-year all-cause death, life expectancy, 5-year MACCE, and 5-year QOL status irrespective of revascularization mode. (C) 2021 by the American College of Cardiology Foundation.

KW - CABG

KW - elderly

KW - life expectancy

KW - long-term outcome

KW - PCI

KW - SYNTAX

KW - BYPASS GRAFT-SURGERY

KW - INTERVENTION

KW - OUTCOMES

KW - TRIAL

KW - THERAPY

U2 - 10.1016/j.jacc.2021.04.016

DO - 10.1016/j.jacc.2021.04.016

M3 - Article

SN - 0735-1097

VL - 77

SP - 2761

EP - 2773

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 22

ER -

10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease

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Keywords

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