Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 27;15(12):1231-1242.
doi: 10.1016/j.jcin.2022.04.025. Epub 2022 May 17.

Predicted and Observed Mortality at 10 Years in Patients With Bifurcation Lesions in the SYNTAX Trial

Kai Ninomiya  1 , Patrick W Serruys  2 , Scot Garg  3 , Chao Gao  4 , Shinichiro Masuda  1 , Mattia Lunardi  1 , Jens F Lassen  5 , Adrian P Banning  6 , Antonio Colombo  7 , Francesco Burzotta  8 , Marie-Claude Morice  9 , Michael J Mack  10 , David R Holmes  11 , Piroze M Davierwala  12 , Daniel J F M Thuijs  13 , David van Klaveren  14 , Yoshinobu Onuma  1 ; SYNTAX Extended Survival Investigators
Affiliations
Free article

Predicted and Observed Mortality at 10 Years in Patients With Bifurcation Lesions in the SYNTAX Trial

Kai Ninomiya et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Percutaneous coronary intervention (PCI) of bifurcation lesions is associated with higher rates of adverse events, and currently it is unclear whether PCI or coronary artery bypass grafting (CABG) is the safer treatment for these patients at very long-term follow-up.

Objectives: The aim of this study was to investigate the impact of bifurcation lesions on individual predicted and observed all-cause 10-year mortality in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial.

Methods: In the SYNTAXES (SYNTAX Extended Survival) study, 10-year observed and individual predicted mortality derived from the SYNTAX score 2020 (SS-2020) was compared between patients with ≥1 bifurcation (n = 1,300) and those with no bifurcations (n = 487).

Results: Among patients treated with PCI, patients with >1 bifurcation lesion compared with those without bifurcation lesions had a significantly higher risk for all-cause death (19.8% vs 30.1%; HR: 1.55; 95% CI: 1.12-2.14; P = 0.007), whereas following CABG, mortality was similar in patients with and those without bifurcation lesions (23.3% vs 23.0%; HR: 0.81; 95% CI: 0.59-1.12; P = 0.207; Pinteraction = 0.006). In PCI patients, a 2-stent vs a 1-stent technique was associated with higher mortality (33.3% vs 25.9%; HR: 1.51; 95% CI: 1.06-2.14; P = 0.021). According to the SS-2020, among those with ≥1 bifurcation, there was equipoise for all-cause mortality between PCI and CABG in 2 quartiles of the population, whereas CABG was superior to PCI in the 2 remaining quartiles.

Conclusions: Bifurcation lesions require special attention from the heart team, considering the higher 10-year all-cause mortality associated with PCI. Careful evaluation of bifurcation lesion complexity and calculation of individualized 10-year prognosis using the SS-2020 may therefore be helpful in decision making. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES], NCT03417050; Taxus Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX], NCT00114972).

Keywords: CABG; PCI; SYNTAX; bifurcation lesion; long-term clinical outcomes.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures SYNTAXES was supported by the German Foundation of Heart Research. The SYNTAX trial, during 0- to 5-year follow-up, was funded by Boston Scientific. Both sponsors had no role in study design, data collection, data analyses, and interpretation of the study data and were not involved in the decision to publish the final manuscript. The principal investigators and authors had complete scientific freedom. Dr Ninomiya has received a grant from Abbott Medical Japan, outside the submitted work. Dr Serruys has received institutional grants from Sinomedical Sciences Technology, Sahajanand Medical Technological, Philips/Volcano, Xeltis, and HeartFlow, outside the submitted work. Dr Masuda has received a grant from Terumo, outside the submitted work. Dr Morice is the CEO and a shareholder of CERC, a contract research organization based in Paris, which had no role in this trial. Dr Burzotta has received speaker fees from Abbott, Abiomed, Medtronic, and Terumo. Dr Banning has received an institutional educational grant for a fellowship from Boston Scientific; and has received speaker fees from Boston Scientific, Medtronic, and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

Publication types

Associated data