The SYNTAXES study (NCT03417050) was an investigator-driven, retrospective study which compared long-term survival-data of patients with coronary artery disease (CAD), previously enrolled in the SYNTAX trial (NCT00114972), who were randomized to undergo either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). While previous studies have demonstrated favorable clinical outcomes with use of optimal medical therapy (OMT) in the short- and medium-term, this is the first analysis to explore outcomes over a long-term (10-year) follow-up.
The original SYNTAX trial enrolled 1800 participants; of these, drug information at 5 years following revascularization (by PCI or CABG) was obtained in 1472 patients. Of these patients, 678 (46.1%) were taking OMT; the remaining 794 (53.9%) were not.
OMT was defined as the combination of 4 types of medications: an antiplatelet, a statin, an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and a beta-blocker. Patients were stratified into 3 groups based on if they were taking ≤2, 3, or all 4 OMT agents. The primary endpoint of this analysis was all-cause mortality at 10 years.
The 10-year mortality rate in patients on OMT at 5 years versus patients on ≤2 agents was significantly lower: 13.1% as compared with 19.9% (adjusted hazard ratio [HR] 0.470; 95% CI 0.292-0.757, P=0.002).
The mortality rate in patients on OMT at 5 years was not significantly different than that of patients who were on 3 agents: 13.1% as compared with 12.7% (adjusted HR 0.953; 95% CI 0.617-1.473, P=0.830). Patients on antiplatelet and statin therapy at 5 years had lower all-cause mortality than patients who were not on these drugs. This association was particularly evident in patients who had undergone CABG.
In patients with 3-vessel and/or left main disease who had undergone PCI or CABG, those who followed recommended OMT had significantly better survival rates than those who took ≤2 pharmacologic agents. Authors concluded that these results underscore the importance of continuous secondary prevention therapy in patients with CAD who have undergone coronary revascularization.
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Author: Kelly Schoonderwoerd
Original article: Kawashima H et al. JACC 2021 July 6;78(1):27-38.