Impact of periprocedural major adverse events on 10-year mortality after revascularisation

Background: The long-term prognostic impact of a composite of periprocedural major adverse events (PMAE) following revascularisation for patients with complex coronary artery disease (CAD) has not yet been established.Aims: This study aimed to assess the impact on 10-year mortality of non-fatal PMAE following percutane-ous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Other objectives were to evalu-ate 1) whether PMAE affect mortality predicted by the SYNTAX score II2020 (SSII-2020) and 2) whether optimal medical therapy (OMT) positively affects the prognosis of patients with non-fatal PMAE. Methods: The association between 10-year mortality and non-fatal PMAE occurring within 30 days of PCI or CABG in patients with three-vessel disease and/or left main disease enrolled in the SYNTAXES study was investigated.Results: The main findings are that non-fatal PMAE occurred less frequently following PCI than CABG (11.2% vs 28.2%; p<0.001) and that non-fatal PMAE were an independent predictor of all-cause mortality in the first year post-procedure, but not at 5 or 10 years, in both treatment modalities. PMAE substantially alter the individual predictions of 10-year mortality by the SSII-2020. In patients with non-fatal PMAE, OMT may provide survival benefits during the first year post-procedure as well as in the long term.Conclusions: In patients with complex CAD, non-fatal PMAE were more common following CABG than PCI, but their prognostic impact was similar, being significant in the first year and then diminishing out to 10 years. Patients with non-fatal PMAE may therefore require more careful follow-up and additional pre-ventive treatment in the first year post-procedure.

Automated summary

This study aimed to evaluate the impact of non-fatal periprocedural major adverse events (PMAE) on 10-year mortality and investigate whether PMAE affect mortality predicted by SYNTAX score II 2020 (SSII-2020) and whether optimal medical therapy (OMT) has a positive effect on the prognosis of patients with non-fatal PMAE. The results show that non-fatal PMAE are more common following CABG than PCI, but their prognostic impact is similar, being significant in the first year and then diminishing out to 10 years. Therefore, patients with non-fatal PMAE may require more careful follow-up and additional preventive treatment in the first year post-procedure.