Impact of major infections on 10-year mortality after revascularization in patients with complex coronary artery disease. (15th October 2021)

• Record Type: Journal Article
• Authors: Ono, Masafumi; Kawashima, Hideyuki; Hara, Hironori; Mancone, Massimo; Mack, Michael J.; Holmes, David R.; Morice, Marie-Claude; Kappetein, Arie Pieter; Thuijs, Daniel J.F.M.; Noack, Thilo; Mohr, Friedrich W.; Davierwala, Piroze M.; Onuma, Yoshinobu; Serruys, Patrick W.
• Is Part Of: International journal of cardiology. Volume 341(2021)
• Page Start: 9
• Page End: 12
• Publication Date: 2021-10-15
• Subjects: Major infection -- Complex coronary artery disease -- Revascularization; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.08.013
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The significant interaction between major infection and 5-year mortality after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) for complex coronary artery disease (CAD) was observed previously. However, the very long-term outcomes beyond 5 years remains unclear. Methods and results: This is a subgroup analysis of the SYNTAX Extended Survival (SYNTAXES) trial, which is the extended follow-up of the randomized SYNTAX trial comparing PCI versus CABG in patients with three-vessel disease (3VD) or left-main CAD (LMCAD). Out of 1517 patients enrolled in the SYNTAX trial with available survival status from 5 to 10 years, 140 patients had experienced major infections and survived at 5 years (major infection group). From 5 to 10 years, the mortality of major infection group was 19.8% whereas the mortality of no major infection group was 15.1% ( p = 0.157). After the adjustment of other clinical factors, the risk of mortality from 5 to 10 years did not significantly differ between major infection and no major infection groups (HR: 1.10; 95% CI: 0.62–1.96; p = 0.740). When stratified by the presence or absence of periprocedural major infections, defined as a major infection within 60 days after index procedure, there was also no significant difference in 10-year mortality between two groups (30.8% vs. 24.5%; p = 0.057). Conclusions: Despite the initial association between major infections and 5 years mortality, postprocedural major infection was not evident in the 10 years follow-up, suggesting that the impact of major infection on mortality subsided over time beyond 5 years. Trial registration: SYNTAXES ClinicalTrials.gov reference: NCT03417050 SYNTAX ClinicalTrials.gov reference: NCT00114972 Highlights: Major infection after PCI or CABG increased 5-year mortality risk Major infection in first 5 years was not independent predictor of 10-year mortality The periprocedural major infection did not affect 10-year survival significantly