title: Causes of Death Following PCI Versus CABG in Complex CAD: 5-Year Follow-Up of SYNTAX.
abstract: BACKGROUND
  There are no data available on specific causes of death from randomized trials that have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI).
  
  
  OBJECTIVE
  The purpose of this study was to investigate specific causes of death, and its predictors, after revascularization for complex coronary disease in patients.
  
  
  METHODS
  An independent Clinical Events Committee consisting of expert physicians who were blinded to the study treatment subclassified causes of death as cardiovascular (cardiac and vascular), noncardiovascular, or undetermined according to the trial protocol. Cardiac deaths were classified as sudden cardiac, related to myocardial infarction (MI), and other cardiac deaths.
  
  
  RESULTS
  In the randomized cohort, there were 97 deaths after CABG and 123 deaths after PCI during a 5-year follow-up. After CABG, 49.4% of deaths were cardiovascular, with the greatest cause being heart failure, arrhythmia, or other causes (24.6%), whereas after PCI, the majority of deaths were cardiovascular (67.5%) and as a result of MI (29.3%). The cumulative incidence rates of all-cause death were not significantly different between CABG and PCI (11.4% vs. 13.9%, respectively; p = 0.10), whereas there were significant differences in terms of cardiovascular (5.8% vs. 9.6%, respectively; p = 0.008) and cardiac death (5.3% vs. 9.0%, respectively; p = 0.003), which were caused primarily by a reduction in MI-related death with CABG compared with PCI (0.4% vs. 4.1%, respectively; p <0.0001). Treatment with PCI versus CABG was an independent predictor of cardiac death (hazard ratio: 1.55; 95% confidence interval: 1.09 to 2.33; p = 0.045). The difference in MI-related death was seen largely in patients with diabetes, 3-vessel disease, or high SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries) trial scores.
  
  
  CONCLUSIONS
  During a 5-year follow-up, CABG in comparison with PCI was associated with a significantly reduced rate of MI-related death, which was the leading cause of death after PCI. Treatments following PCI should target reducing post-revascularization spontaneous MI. Furthermore, secondary preventive medication remains essential in reducing events post-revascularization. (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Milan
authors.initials: M
authors.lastname: Milojevic
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Head
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Catalina A
authors.initials: CA
authors.lastname: Parasca
authors.affiliation: Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Department of Cardiovascular Surgery, Herzzentrum Universität Leipzig, Leipzig, Germany.
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.affiliation: Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.affiliation: Department of Cardiovascular Surgery, Heart Hospital Baylor Plano, Baylor Healthcare System, Plano, Texas.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ståhle
authors.affiliation: Cardiology Division, Evanston Hospital, Evanston, Illinois.
authors.forename: Ted E
authors.initials: TE
authors.lastname: Feldman
authors.affiliation: Boston Scientific Corporation, Natick, Massachusetts.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.affiliation: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: holmes.david@mayo.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
mesh_terms: D000368:Aged; D002423:Cause of Death; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality* / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: SYNTAX; cardiac death; cause of death; coronary artery bypass grafting; heart failure; myocardial infarction; percutaneous coronary intervention; stroke; sudden death