title: Incidence and multivariable correlates of long-term mortality in patients treated with surgical or percutaneous revascularization in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial.
abstract: OBJECTIVE
  The aim of this investigation was to determine the incidence and multivariable correlates of long-term (4-year) mortality in patients treated with surgical or percutaneous revascularization in the synergy between percutaneous coronary intervention (PCI) with TAXUS Express and Cardiac Surgery (SYNTAX) trial.
  
  
  RESULTS
  A total of 1800 patients were randomized to undergo coronary artery bypass graft (CABG) surgery (n = 897) or PCI (n = 903). Prospectively collected baseline and peri- and post-procedural data were used to determine independent correlates of 4-year all-cause death in the CABG and the PCI arms (Cox proportional hazards model). Four-year mortality rates in the CABG and the PCI arms were 9.0% [74 deaths (12 in-hospital)] and 11.8% [104 deaths (16 in-hospital)], respectively (log-rank P-value = 0.063). Censored data comprised 78 patients (8.7%) in the CABG arm, and 24 patients (2.7%) in the PCI arm (log-rank P-value < 0.001). Within the CABG arm, the strongest independent correlates of 4-year mortality were lack of discharge aspirin [hazard ratio (HR) 3.56; 95% CI: 2.04, 6.21; P < 0.001], peripheral vascular disease (PVD) (HR: 2.65; 95% CI: 1.49, 4.72; P = 0.001), chronic obstructive pulmonary disease, age, and serum creatinine. Within the PCI arm, the strongest independent correlate of 4-year mortality was lack of post-procedural anti-platelet therapy (HR: 152.16; 95% CI: 53.57, 432.22; P < 0.001), with 10 reported early (within 45 days) in-hospital deaths secondary to multifactorial causes precluding administration of anti-platelet therapy. Other independent correlates of mortality in the PCI arm included amiodarone therapy on discharge, pre-procedural poor left ventricular ejection fraction, a 'history of gastrointestinal bleeding or peptic ulcer disease', PVD (HR: 2.13; 95% CI: 1.26, 3.60; P = 0.005), age, female gender (HR: 1.60; 95% CI: 1.01, 2.56; P = 0.048), and the SYNTAX score (Per increase in 10 points: HR: 1.25; 95% CI: 1.06, 1.47; P = 0.007).
  
  
  CONCLUSIONS
  Independent correlates of 4-year mortality in the SYNTAX trial were multifactorial. Lack of discharge aspirin and lack of post-procedural anti-platelet therapy were the strongest independent correlates of mortality in the CABG and the PCI arms, respectively. Peripheral vascular disease is a common independent correlate of 4-year mortality and may be a marker of the severity of baseline coronary disease and risk of future native coronary disease (and extra-cardiac disease) progression.
authors.affiliation: Department of Interventional Cardiology,  Erasmus University Medical Centre, Thoraxcenter, s-Gravendijkwal 230, 3015 CE, Rotterdam,  The Netherlands.
authors.forename: Vasim
authors.initials: V
authors.lastname: Farooq
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Christos
authors.initials: C
authors.lastname: Bourantas
authors.forename: Pascal
authors.initials: P
authors.lastname: Vranckx
authors.forename: Roberto
authors.initials: R
authors.lastname: Diletti
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia Garcia
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Arie-Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
authors.forename: Marie Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Marie-angèle
authors.initials: MA
authors.lastname: Morel
authors.forename: Ton
authors.initials: T
authors.lastname: de Vries
authors.forename: Gerrit Anne
authors.initials: GA
authors.lastname: van Es
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: Stefan
authors.initials: S
authors.lastname: James
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ståhle
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000401:mortality; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012737:Sex Factors; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D000638:Amiodarone