Impact of preprocedural biological markers on 10-year mortality in the SYNTAXES trial

Abstract

Background: Creatinine clearance (CrCl) is an independent determinant of mortality in predictive models of revascularisation outcomes for complex coronary artery disease.Aims: This study aimed to investigate the impact of preprocedural biological markers on 10-year mortality following coronary revascularisation. Methods:The SYNTAX Extended Survival (SYNTAXES) study evaluated the 10-year vital status followup of 1,800 patients with de novo three-vessel (3VD) and/or left main coronary artery disease (LMCAD) randomised to include percutaneous or surgical coronary revascularisation. The associations between mortality and preprocedural C-reactive protein (CRP), haemoglobin, HbA1c, CrCl, fasting triglycerides, lowdensity lipoprotein cholesterol, and high-density lipoprotein cholesterol were analysed.Results: Out of 1,800 patients, 460 patients died before the 10-year follow-up. CRP, HbA1c and CrCl with threshold values of ≥2 mg/L, ≥6% (42 mmol/mol) and <60 ml/min, respectively, were associated with 10-year all-cause death (adjusted hazard ratio [95% confidence interval]: 1.35 [1.01-1.82], 1.51 [1.16-1.95], and 1.46 [1.07-2.00], respectively). There was no significant interaction between the biological markers on all-cause mortality and the type of revascularisation. Preprocedural lipid markers were not significantly associated with 10-year all-cause death, but the non-use of statins was a determinant factor of worse prognosis (adjusted hazard ratio [95% confidence interval]: 1.68 [1.26-2.25]). Conclusions:Preprocedural biomarkers, such as CRP and HbA1c, are associated with long-term mortality post revascularisation, regardless of the revascularisation technique. Conventional lipidic biomarkers associated with high-risk of cardiovascular events seem to be effectively mitigated by the long-term use of statins, whereas the non-use of statins was a factor of a worse prognosis, emphasising the importance of pharmacological treatment. Trial registration: SYNTAXES ClinicalTrials.gov: NCT03417050. SYNTAX ClinicalTrials.gov: NCT00114972.

A systematic screening and heart team approach contributes to unravel novel risk factors in revascularisation candidates of complex coronary artery disease: a machine learning approach

“…In 2021, Hara et al reported that pre-procedural biological parameters, such as CRP and Hb were associated with 10-year mortality post-revascularization, regardless of revascularization technique. [16] In our study, the ML model was built using a combination of baseline clinical characteristics, biochemical and imaging parameters and unconventional potentially important prognostic factors, such as pulmonary hypertension, CRP, Hb, carotid disease, and total occlusion which were all found to play a key role in predicting 5-year all-cause death.…”

10 Years of SYNTAX

“…Inclusion of biological markers into the SSII-2020 did not significantly improve predictivity. 20 As is discussed later in contrast to the SSII-2020, machine learning (ML) algorithms identified CRP as one variable able to predict 10-year mortality ( Table 3 ).

Figure 8 All-Cause Mortality at 10 Years With Respect to Biological Markers Mortality rates according to (A) C-reactive protein (CRP), (B) hemoglobin, (C) HbA1c, (D) creatinine clearance (CrCl), (E) triglycerides (TG), (F) low-density lipoprotein cholesterol (LDL-C), and (G) high-density lipoprotein cholesterol (HDL-C).

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