o:3250 Mortality 10 years after percutaneous or surgical revascularization in patients with total coronary artery occlusions en BACKGROUND: The long-term clinical benefit after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with total occlusions (TOs) and complex coronary artery disease has not yet been clarified. OBJECTIVES: The objective of this analysis was to assess 10-year all-cause mortality in patients with TOs undergoing PCI or CABG. METHODS: This is a subanalysis of patients with at least 1 TO in the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which investigated 10-year all-cause mortality in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial, beyond its original 5-year follow-up. Patients with TOs were further stratified according to the status of TO recanalization or revascularization. RESULTS: Of 1,800 randomized patients to the PCI or CABG arm, 460 patients had at least 1 lesion of TO. In patients with TOs, the status of TO recanalization or revascularization was not associated with 10-year all-cause mortality, irrespective of the assigned treatment (PCI arm: 29.9% vs. 29.4%; adjusted hazard ratio [HR]: 0.992; 95% confidence interval [CI]: 0.474 to 2.075; p 1⁄4 0.982; and CABG arm: 28.0% vs. 21.4%; adjusted HR: 0.656; 95% CI: 0.281 to 1.533; p 1⁄4 0.330). When TOs existed in left main and/or left anterior descending artery, the status of TO recanalization or revascularization did not have an impact on the mortality (34.5% vs. 26.9%; adjusted HR: 0.896; 95% CI: 0.314 to 2.555; p 1⁄4 0.837). CONCLUSIONS: At 10-year follow-up, the status of TO recanalization or revascularization did not affect mortality, irrespective of the assigned treatment and location of TOs. The present study might support contemporary practice among high-volume chronic TO-PCI centers where recanalization is primarily offered to patients for the management of angina refractory to medical therapy when myocardial viability is confirmed. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972) Appendix: https://unilib.phaidrabg.rs/o:3251 Key words: coronary artery bypass grafting, long-term mortality, percutaneous coronary intervention, SYNTAX, total occlusion, 91552100 128582409 1552101 0735-1097 1552099 10.1016/j.jacc.2020.11.055 2023-11-16T20:56:06.159Z 44 yes 46 Hideyuki Kawashima 106259465 2021 46 Kuniaki Takahashi 46 Masafumi Ono 46 Hironori Hara 46 Rutao Wang 46 Chao Gao 46 Faisal Sharif 46 Michael J. Mack 46 David R. Holmes 46 Marie-Claude Morice 46 Stuart J. Head 46 Arie Pieter Kappetein 46 Daniel J.F.M. Thuijs 46 Milan Milojević 106163721 0000-0003-0984-9011 2021 46 Thilo Noack 46 Friedrich-Wilhelm Mohr 46 Piroze M. Davierwala 46 Patrick W. Serruys 46 Yoshinobu Onuma 46 SYNTAX Extended Survival Investigators institution application/pdf 723783 https://unilib.phaidrabg.rs/o:3250 no yes 1 70 616.132.2-089-036.8 92000001 71A11 Journal of the American College of Cardiology 77 5 529 540 2021