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. 2022 Dec 1:368:28-38.
doi: 10.1016/j.ijcard.2022.08.013. Epub 2022 Aug 6.

Geographic disparity in 10-year mortality after coronary artery revascularization in the SYNTAXES trial

Shigetaka Kageyama  1 , Patrick W Serruys  2 , Scot Garg  3 , Kai Ninomiya  1 , Shinichiro Masuda  1 , Nozomi Kotoku  1 , Antonio Colombo  4 , Michael J Mack  5 , Adrian P Banning  6 , Marie-Claude Morice  7 , Adam Witkowski  8 , Nick Curzen  9 , Francesco Burzotta  10 , Stefan James  11 , Robert-Jan van Geuns  12 , Piroze M Davierwala  13 , David R Holmes Jr  14 , David A Wood  15 , John William McEvoy  16 , Yoshinobu Onuma  1 ; SYNTAX Extended Survival Investigators
Affiliations

Geographic disparity in 10-year mortality after coronary artery revascularization in the SYNTAXES trial

Shigetaka Kageyama et al. Int J Cardiol. .

Abstract

Aims: To investigate geographic disparity in long-term mortality following revascularization in patients with complex coronary artery disease (CAD).

Methods and results: The SYNTAXES trial randomized 1800 patients with three-vessel and/or left main CAD to percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and assessed their survival at 10 years. Patients were stratified according to the region of recruitment: North America (N-A, n = 245), Eastern Europe (E-E, n = 189), Northern Europe (N-E, n = 425), Southern Europe (S-E, n = 263), and Western Europe (W-E, n = 678), which also served as the reference group. Compared to W-E, patients were younger in E-E (62 vs 65 years, p < 0.001), and less frequently male in N-A (65.3% vs 79.6%, p < 0.001). Diabetes (16.0% vs 25.4%, p < 0.001) and peripheral vascular disease (6.8% vs 10.9%, p = 0.025) were less frequent in N-E than W-E. Ejection fraction was highest in W-E (62% vs 56%, p < 0.001). Compared to W-E, the mean anatomic SYNTAX score was higher in S-E (29 vs 31, p = 0.008) and lower in N-A (26, p < 0.001). Crude ten-year mortality was similar in N-A (31.6%), and W-E (30.7%), and significantly lower in E-E (22.5%, p = 0.041), N-E (21.9%, p = 0.003) and S-E (22.0%, p = 0.014). Compared to W-E, adjusted mortality in N-E (HR 0.85, p = 0.019) and S-E (HR 0.72, p = 0.043) remain significantly lower after adjustment for pre- and peri-procedural factors, but no significant interaction (Pinteraction = 0.728) between region and modality of revascularization was seen.

Conclusion: In the era of globalization, knowledge, and understanding of geographic disparity are of paramount importance for the correct interpretation of global studies.

Keywords: Complex coronary artery disease; Geographic disparity; Revascularization; Ten-year mortality.

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