Rutao Wang1,2,3, Mariusz Tomaniak4,5, Kuniaki Takahashi6, Chao Gao1,2,3, Hideyuki Kawashima2,6, Hironori Hara2,6, Masafumi Ono2,6, David van Klaveren7,8, Robert-Jan van Geuns3, Marie-Claude Morice9, Piroze M Davierwala10, Michael J Mack11, Adam Witkowski12, Nick Curzen13, Sergio Berti14, Francesco Burzotta15, Stefan James16, Arie Pieter Kappetein17, Stuart J Head17, Daniel J F M Thuijs17, Friedrich W Mohr10, David R Holmes18, Ling Tao1, Yoshinobu Onuma2, Patrick W Serruys19,20,21. 1. Department of Cardiology, Xijing Hospital, Xi'an, China. 2. Department of Cardiology, National University of Ireland, Galway (NUIG), P.O. University Road, Galway, H91 TK33, Ireland. 3. Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands. 4. First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. 5. Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands. 6. Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 7. Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. 8. Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, USA. 9. ICPS Ramsay-Generale de Sante, Massy, France. 10. Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany. 11. Baylor Scott & White Health, Plano, TX, USA. 12. Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland. 13. Cardiology Department, University Hospital Southampton, Southampton, UK. 14. Cardiology Department, Heart Hospital-Fondazione C.N.R. Reg. Toscana G. Monasterio, Massa, Italy. 15. Institute of Cardiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 16. Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. 17. Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. 18. Mayo Clinic, Rochester, MN, USA. 19. Department of Cardiology, National University of Ireland, Galway (NUIG), P.O. University Road, Galway, H91 TK33, Ireland. patrick.w.j.c.serruys@gmail.com. 20. NHLI, Imperial College London, London, UK. patrick.w.j.c.serruys@gmail.com. 21. Erasmus University Medical Center, Rotterdam, The Netherlands. patrick.w.j.c.serruys@gmail.com.
Abstract
AIMS: To evaluate the impact of chronic obstructive pulmonary disease (COPD) on 10-year all-cause death and the treatment effect of CABG versus PCI on 10-year all-cause death in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) and COPD. METHODS: Patients were stratified according to COPD status and compared with regard to clinical outcomes. Ten-year all-cause death was examined according to the presence of COPD and the revascularization strategy. RESULTS:COPD status was available for all randomized 1800 patients, of whom, 154 had COPD (8.6%) at the time of randomization. Regardless of the revascularization strategy, patients with COPD had a higher risk of 10-year all-cause death, compared with those without COPD (43.1% vs. 24.9%; hazard ratio [HR]: 2.03; 95% confidence interval [CI]: 1.56-2.64; p < 0.001). Among patients with COPD, CABG appeared to have a slightly lower risk of 10-year all-cause death compared with PCI (42.3% vs. 43.9%; HR: 0.96; 95% CI: 0.59-1.56, p = 0.858), whereas among those without COPD, CABG had a significantly lower risk of 10-year all-cause death (22.7% vs. 27.1%; HR: 0.81; 95% CI: 0.67-0.99, p = 0.041). There was no significant differential treatment effect of CABG versus PCI on 10-year all-cause death between patients with and without COPD (p interaction = 0.544). CONCLUSIONS: COPD was associated with a higher risk of 10-year all-cause death after revascularization for complex coronary artery disease. The presence of COPD did not significantly modify the beneficial effect of CABG versus PCI on 10-year all-cause death. TRIAL REGISTRATION: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.
RCT Entities:
AIMS: To evaluate the impact of chronic obstructive pulmonary disease (COPD) on 10-year all-cause death and the treatment effect of CABG versus PCI on 10-year all-cause death in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) and COPD. METHODS:Patients were stratified according to COPD status and compared with regard to clinical outcomes. Ten-year all-cause death was examined according to the presence of COPD and the revascularization strategy. RESULTS:COPD status was available for all randomized 1800 patients, of whom, 154 had COPD (8.6%) at the time of randomization. Regardless of the revascularization strategy, patients with COPD had a higher risk of 10-year all-cause death, compared with those without COPD (43.1% vs. 24.9%; hazard ratio [HR]: 2.03; 95% confidence interval [CI]: 1.56-2.64; p < 0.001). Among patients with COPD, CABG appeared to have a slightly lower risk of 10-year all-cause death compared with PCI (42.3% vs. 43.9%; HR: 0.96; 95% CI: 0.59-1.56, p = 0.858), whereas among those without COPD, CABG had a significantly lower risk of 10-year all-cause death (22.7% vs. 27.1%; HR: 0.81; 95% CI: 0.67-0.99, p = 0.041). There was no significant differential treatment effect of CABG versus PCI on 10-year all-cause death between patients with and without COPD (p interaction = 0.544). CONCLUSIONS:COPD was associated with a higher risk of 10-year all-cause death after revascularization for complex coronary artery disease. The presence of COPD did not significantly modify the beneficial effect of CABG versus PCI on 10-year all-cause death. TRIAL REGISTRATION: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.
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