Coronary lesion complexity in patients with familial hypercholesterolemia hospitalized for an acute myocardial infarction: data from the French RICO Survey

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Yao ◽  
M Farnier ◽  
C Salignon-Vernay ◽  
F Chague ◽  
P Brunel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Statin Treatment ◽  
Public Institution ◽  
Syntax Score ◽  
Funding Source ◽  
Lipid Clinic ◽  
Complex Anatomy ◽  
Acute Mi ◽  
Artery Disease

Abstract Background Although patients with familial heterozygous hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI), coronary artery disease (CAD) burden of FH patients with acute MI remains to be investigated. Methods All consecutive patients hospitalized for an acute MI in a multicenter database (RICO) from 2012–2017 who underwent coronary angiography were considered. FH (n=86) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥6). The angiographic features of FH patients were compared with patients without FH (score 0–2) (n=166), after matching for age, sex and diabetes (1:2). Results When compared with patients without FH, patients with FH had higher prevalence of personal and familial history of CAD (17 vs 5%, and 74 vs 5%, p=0.002 and p<0.001, respectively), and hypertension (54 vs 36%, p=0.006). Chronic statin treatment was used in only 45% of FH patients. At coronary angiography, FH had increased extent of CAD (SYNTAX score 11 (4–21) vs 8 (3–16), p=0.049) and multivessel disease (58% vs 43%, p=0.021). Significant stenosis was more frequent in left and right marginal coronary arteries. FH patients showed a trend toward more complex lesions, with less thrombus (28 vs 39%, p=0.076), but a 2 times higher rate of bifurcation lesions and calcifications (23 vs 12% and 20 vs 10%, p=0.021 and p=0.036). Conclusions This study addressing the coronary lesions features of FH patients with acute MI shows that FH patients had more severe CAD burden, and were characterized by complex anatomy features. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ARS Bourgogne Franche Comté, CHU Dijon Bourgogne

scholarly journals Coronary lesion complexity in patients with heterozygous familial hypercholesterolemia hospitalized for acute myocardial infarction: data from the RICO survey

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Hermann Yao ◽  
Michel Farnier ◽  
Laura Tribouillard ◽  
Frédéric Chague ◽  
Philippe Brunel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Ldl Cholesterol ◽  
Statin Treatment ◽  
Lipid Lowering ◽  
Syntax Score ◽  
Lipid Lowering Therapy ◽  
Lipid Clinic ◽  
Acute Mi ◽  
Artery Disease

Abstract Background Although patients with familial heterozygous hypercholesterolemia (FH) have a high risk of early myocardial infarction (MI), the coronary artery disease (CAD) burden in FH patients with acute MI remains to be investigated. Methods The data for all consecutive patients hospitalized in 2012–2019 for an acute MI and who underwent coronary angiography were collected from a multicenter database (RICO database). FH (n = 120) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥ 6). We compared the angiographic features of MI patients with and without FH (score 0–2) (n = 234) after matching for age, sex, and diabetes (1:2). Results Although LDL-cholesterol was high (208 [174–239] mg/dl), less than half of FH patients had chronic statin treatment. When compared with non-FH patients, FH increased the extent of CAD (as assessed by SYNTAX score; P = 0.005), and was associated with more frequent multivessel disease (P = 0.004), multiple complex lesions (P = 0.022) and significant stenosis location on left circumflex and right coronary arteries. Moreover, FH patients had more multiple lesions, with an increased rate of bifurcation lesions or calcifications (P = 0.021 and P = 0.036, respectively). In multivariate analysis, LDL-cholesterol levels (OR 1.948; 95% CI 1.090–3.480, P = 0.024) remained an independent estimator of anatomical complexity of coronary lesions, in addition to age (OR 1.035; 95% CI 1.014–1.057, P = 0.001). Conclusions FH patients with acute MI had more severe CAD, characterized by complex anatomical features that are mainly dependent on the LDL-cholesterol burden. Our findings reinforce the need for more aggressive preventive strategies in these high-risk patients, and for intensive lipid-lowering therapy as secondary prevention.

High levels of lipoprotein(a) are associated with the severity of coronary disease in patients with acute myocardial infarction. Data from the RICO survey

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Farnier ◽  
H Yao ◽  
N Hounton ◽  
M Maza ◽  
F Chague ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Angiography ◽  
Public Institution ◽  
Syntax Score ◽  
Funding Source ◽  
Lipoprotein A ◽  
History Of ◽  
Acute Mi ◽  
Very High

Abstract Background High level of Lipoprotein(a), Lp(a), is a well-recognised independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, limited data are available on the prevalence of high Lp(a) levels and on the threshold associated to coronary artery disease (CAD) burden in patients with acute myocardial infarction (MI). Methods We aim at assessing CAD burden in 651 consecutive patients hospitalized for an acute MI from January 2019 to September 2019 who underwent coronary angiography. Patients characteristics and angiographic features were compared for patients with Lp(a) <50 mg/dL (normal), ≥50 mg/dL (high) and >80 mg/dL (i.e >90th percentile) (very high). Results The prevalence of Lp(a) ≥50 mg/dL was elevated (19.0%) and 65 patients (10.0%) were in the >90th percentile. Median (IQR) age was similar across the 3 groups (normal: 68 (59–79)y; high: 74 (63–80)y; very high: 71 (57–82)y, p=0.239). When compared with patients with normal Lp(a), patients with very high levels (≥80 mg/dL) had higher prevalence of personal history of ASCVD (29 vs 16%, p=0.021) and family history of CAD (37 vs 19%, p=0.005), and were more frequently women (43 vs 29%, p=0.009). At coronary angiography, patients with very high Lp(a) levels had increased extent of CAD (Median SYNTAX score 17 (5–25) vs 10 (5–17), p=0.002) and more frequent multivessel disease (69 vs 54%, p=0.02). Conclusion Among real world patients hospitalized for an acute MI, Lp(a) levels >80 mg/dL are associated with an increased CAD burden and this threshold identifies a subset of patients with features of high ASCVD risk. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ARS Bourgogne Franche Comté; CHU Dijon Bourgogne

Socioeconomic status influences delays in the management of acute ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Cetran ◽  
E Lesaine ◽  
S Miganeh-Hadi ◽  
F Sevin ◽  
F Saillour-Glenisson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Symptom Onset ◽  
Public Institution ◽  
St Elevation Myocardial Infarction ◽  
Ecological Indicator ◽  
Low Ses ◽  
Funding Source ◽  
Acute Stemi ◽  
St Elevation

Abstract Background A prompt diagnosis to initiate the appropriate reperfusion therapy is crucial to improve clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients. Socio-economic status (SES) refers to parameters like income, educational status and occupation. A low SES negatively interferes with the prognosis of STEMI patients. However, the impact of SES on delay time in acute STEMI remains matter of debate. Methods We used databases from two French multicentric and prospective registries: ACIRA (patients undergoing coronary angiography in any catheterization laboratories of Aquitaine) and REANIM (acute STEMI patients supported by emergency medical system (EMS) in Aquitaine). An ecological indicator of social deprivation Fdep09 was calculated to describe geographical inequalities in health based on municipality of residence. The higher the value, the more disadvantaged the population. Low SES was defined as Fdep09 > median value. Results Two-thousand-eight-hundred-and-forty consecutive patients with acute STEMI undergoing coronary angiography from January 2017 to December 2018 in Aquitaine were included. Patients with lower SES were more often initially referred to emergency departments of non-percutaneous coronary intervention capable centers whereas patients with higher SES were more often directly transferred to PCI centers by the mobile emergency care units as recommended by the most recent European guidelines (p<10–4). Patients with low SES had longer delays from symptom onset to first medical contact (FMC) (116 [60–119] vs 98 [55–233] min, p=0.0078) and were more likely to receive fibrinolysis (9.9 vs 5.2%, p<10–4). Linear regression modeling showed that each point of the Fdep09 index was associated with increase in the delay from symptom onset to FMC by a factor 1.1 (95% CI: 1.04–1.17, p<10–3) after adjusting for potential confounders. Conclusion SES inequality has negative influence on the delays in the management of acute STEMI patients. Efforts to raise awareness of suspicious signs of acute MI among individuals in lower SES could be valuable. FDep09 distribution Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ARS Nouvelle-Aquitaine

scholarly journals 2214Prevalence and severity of coronary disease in patients with familial hypercholesterolemia hospitalized for an acute myocardial infarction: data from the RICO survey

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Farnier ◽  
B Mouhat ◽  
T Pommier ◽  
H Yao ◽  
M Maza ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Familial Hypercholesterolemia ◽  
Statin Treatment ◽  
University Hospital ◽  
Lipid Lowering ◽  
Syntax Score ◽  
World Population ◽  
Lipid Lowering Therapy ◽  
History Of ◽  
Acute Mi

Abstract Aim Individuals with heterozygous familial hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI). However, coronary artery disease (CAD) burden of FH remains not well described. From a large database of a regional registry of acute MI, we aimed to address prevalence of FH and severity of CAD. Methods Consecutive patients hospitalized with MI in a multicentre database from 2001–2017 were considered. An algorithm, adapted from Dutch Lipid Clinic Network criteria, was built upon 4 variables (LDL-cholesterol (LDL-C) and lipid lowering agents, premature and family history of CAD) to identify FH probabilities. Results Among the 11624 patients included in the survey, 249 (2.1%) had probable/definite FH (score ≥6), and 2405 (20.7%) had possible FH (score 3–5). When compared with patients without FH (score 0–2), FH patients (score ≥6) were 20y younger (51 (46–57) vs 71 (61–80) y, p<0.001), with a lower rate of hypertension (47 vs 59%, p<0.001), diabetes (17 vs 25%, p<0.001) and prior stroke (4 vs 8%, p=0.016), but a higher prevalence of smokers (56 vs 23%, p<0.001), personal (20 vs 15%, p=0.02) or familial history of CAD (78 vs 18%, p<0.001). Chronic statin treatment was only used in 48% of FH patients and ezetimibe in 8%. After adjustment for age, sex and diabetes, FH patients were characterized by increased extent of CAD (syntax score 11 (4–19) vs 7 (1–13), p<0.001) and multivessel disease (55 vs 40%, p<0.001). Conclusion In this large real world population of acute MI, a high prevalence of FH was found. FH patients were characterized by their young age associated with the severity of CAD burden and limited use of preventive lipid lowering therapy. Acknowledgement/Funding University Hospital Center Dijon Bourgogne, Agence Régionale de Santé Bourgogne Franche Comté, France

Diabetes is not a risk factor for myocardial infarction in patients without coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Gyldenkerne ◽  
K.K.W Olesen ◽  
P.G Thrane ◽  
M Madsen ◽  
T Thim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiac Death ◽  
Coronary Revascularization ◽  
Hazard Ratio ◽  
Funding Source ◽  
Artery Disease

Abstract Background Diabetes is considered a risk factor for myocardial infarction (MI). However, we have previously found that diabetes was not a short-term risk factor for MI in the absence of obstructive coronary artery disease (CAD). Purpose As long-term data are not available, we aimed to assess adverse cardiac events in patients with and without diabetes stratified by CAD up to 11 years after coronary angiography. Methods We conducted a cohort study of patients undergoing coronary angiography from 2003 to 2012 and followed them by cross-linking Danish health registries. Patients were stratified according to the presence/absence of CAD and diabetes. Outcomes included MI, cardiac death, all-cause death, and coronary revascularization. Results A total of 86,202 patients were included (diabetes: n=12,652). Median follow-up was 8.8 years. Using patients with neither CAD nor diabetes as reference (cumulative MI incidence 2.6%), the risk of MI was similar for patients with diabetes alone (3.2%; hazard ratio 1.202, 95% CI: 0.996–1.451), was increased for patients with CAD alone (9.3%; hazard ratio 2.75, 95% CI: 2.52–3.01), and was highest for patients with both CAD and diabetes (12.3%; hazard ratio 3.79, 95% CI: 3.43–4.20), see Figure. Similar associations were observed for cardiac death and coronary revascularization. Conclusions Diabetes patients without CAD by coronary angiography have a similar risk of MI compared to patients with neither CAD nor diabetes. In the presence of CAD, however, diabetes increases the risk of MI. Figure 1 Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): The Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

scholarly journals Association between Serum Osteoprotegerin Levels and Severity of Coronary Artery Disease in Patients with Acute Myocardial Infarction

2021 ◽  
Vol 10 (19) ◽  
pp. 4326
Author(s):  
Yves Cottin ◽  
Rany Issa ◽  
Mourad Benalia ◽  
Basile Mouhat ◽  
Alexandre Meloux ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Syntax Score ◽  
Acute Mi ◽  
Coronary Lesions ◽  
Artery Disease

Background. Osteoprotegerin (OPG), a glycoprotein of the tumour necrosis factor (TNF) superfamily, is one of the main biomarkers for vascular calcification. Aim. We aimed to evaluate the association between serum OPG levels and extent of coronary lesions in patients with acute myocardial infarction (MI). Methods. Consecutive patients hospitalized for an acute MI who underwent coronary angiography were included. SYNTAX score was calculated to assess the severity of coronary artery disease. The population was analysed in low (5 (3–6)), medium (11 (9–13)) and high (20 (18–23)) tertiles of SYNTAX score. Results. Among the 378 patients included, there was a gradual increase in age, rate of diabetes, anterior wall location, and a reduction in left ventricular ejection fraction across the SYNTAX tertiles. OPG levels significantly increased across the tertiles (962 (782–1497), 1240 (870–1707), and 1464 (1011–2129) pg/mL, respectively (p < 0.001)). In multivariate analysis, OPG [OR(CI95%): 2.10 (1.29–3.49) 0.003], were associated with the high SYNTAX group, beyond hypercholesterolemia, CV history and reduced glomerular filtration rate. Conclusion. We found an association between OPG levels and coronary lesions complexity patients with acute MI.

scholarly journals Association between serum osteoprotegerin levels and severity of coronary artery disease in patients with acute myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Y Cottin ◽  
R Issa ◽  
M Benalia ◽  
B Mouhat ◽  
A Meloux ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Syntax Score ◽  
Acute Mi ◽  
Coronary Lesions ◽  
Artery Disease

Abstract Background Osteoprotegerin (OPG), a glycoprotein of the tumor necrosis factor (TNF) superfamily is a main biomarker for vascular calcification. Aim We aimed to evaluate the association between serum OPG levels and extent of coronary lesions in patients with acute myocardial infarction (MI). Methods Consecutive patients hospitalized for an acute MI who underwent coronary angiography were included. SYNTAX score was calculated to assess the severity of coronary artery disease. The population was analysed in low (5 (3–6)), medium (11 (9–13)) and high (20 (18–23)) tertiles of SYNTAX score. Results Among the 378 patients included, there was a gradual increase in age, rate of diabetes, anterior wall location, and a reduction in left ventricular ejection fraction across the SYNTAX tertiles. OPG levels significantly increased across the tertiles (962 (782–1,497), 1,240 (870–1,707), and 1464 (1,011–2,129) pg/ml, respectively (p&lt;0.001)). In multivariate analysis, OPG [OR (CI95%): 2.09 (1.31–3.32) p=0. 002], were associated with the high SYNTAX group, beyond hypercholesterolemia, CV history and creatinine. Conclusion We found an association between OPG levels and coronary lesions complexity patients with acute MI. Determining OPG levels in combination with an ischemia test could be used in the clinical setting for the early diagnosis of subclinical atherosclerosis. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): CHU Dijon BourgogneConseil Régional Bourgogne Franche Comté

scholarly journals High levels of lipoprotein(a) are associated with the severity of coronary disease in patients with acute myocardial infarction. Data from the RICO survey

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Farnier ◽  
F Chague ◽  
M Maza ◽  
F Bichat ◽  
J C Beer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Angiography ◽  
Syntax Score ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipoprotein A ◽  
Funding Sources ◽  
Acute Mi ◽  
High Level ◽  
Very High

Abstract Background High level of lipoprotein(a), Lp(a), is a well-recognized independent risk factor for atherosclerotic cardiovascular disease (ASCVD) including acute myocardial infarction (MI). However, limited data are available on the relationship between coronary artery disease (CAD) burden and Lp(a) levels in patients with acute MI. Methods CAD burden was addressed in 1213 consecutive patients hospitalized for an acute MI in 2019–2020 who underwent coronary angiography from the RICO survey. Patients were compared according to Lp(a) levels (Lp(a) &lt;50 mg/dL (normal), ≥50 mg/dL and ≤100 mg/dL (high) and &gt;100 mg/dL (very high)). Results The prevalence of high and very high Lp(a) was elevated (13% and 6%, respectively). Median (IQR) age (normal: 68 (58–79)y; high: 70 (61–80)y; very high: 69 (60–78)y, p=0.502) and rate of diabetes (p=0.448) were similar across the 3 groups. When compared with normal Lp(a), patients with very high Lp(a) had more frequently hypertension, were more often under chronic statin therapy and their corrected LDL-cholesterol was lower. There was a gradual increase in prior ASCVD rates across the 3 Lp(a) groups (p=0.001). When compared with patients with high or normal Lp(a), patients with very high Lp(a) levels had elevated SYNTAX score at coronary angiography, (17 (6–25) vs 12 (6–19) and 10 (5–18), p=0.006, respectively), and had more frequently multivessel disease (74% vs 64% and 56%, p=0.003). By multivariate analysis, very high Lp(a) (OR(95% CI): 1.879 (1.065–3.312)) remained associated with high CAD burden, beyond confounding including age, diabetes and dyslipidemia. Conclusion Among real world patients hospitalized for an acute MI, high Lp(a) levels are common (≈20%) and independently associated with a severe CAD burden, beyond traditional risk factors, identifying a subset of patients with features of high ASCVD risk. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): CHU Dijon Bourgogne ARS Bourgogne Franche Comté

scholarly journals To Assess Relationship of Lipoprotein (a) with Severity of Coronary Artery Disease in Patients with Acute Myocardial Infarction: A Hospital based Cross-sectional Study

2021 ◽  
Author(s):  
Gaurav Bhandari ◽  
Girish Rajadhyaksha ◽  
Meghav Shah
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Angiography ◽  
Cross Sectional Study ◽  
P Value ◽  
Syntax Score ◽  
Sectional Study ◽  
Cross Sectional ◽  
Artery Disease ◽  
Relationship Of

Introduction: Elevated plasma concentrations of lipoprotein {Lp(a)} have been consistently shown to be a risk factor for the development of a spectrum of thrombotic and atherosclerotic disorders including Coronary Artery Disease (CAD). Aim: To assess relationship of Lp(a) with severity of CAD in patients of Acute Myocardial Infarction (AMI). Materials and Methods: A hospital based, cross-sectional study was conducted at Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India, between November 2016 to April 2018 (18 months). A total of 200 diagnosed cases of AMI who were willing to undergo coronary angiography were enrolled for this study. Prior to coronary angiography, a fasting blood sample was assessed for lipids and Lp(a) levels. The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score was calculated according to the coronary angiography results. Patients were divided into two groups based on Lp(a) levels: <25 mg/dL and >25 mg/dL and categorised based on CAD severity and SYNTAX scores as low (<22), intermediate (23-32) and high (>32). Lp(a) levels were categorised as low (<25 mg/dL) and high (>25 mg/dL). A p-value of <0.05 was considered as statistically significant. The statistical evaluation of data was done using the Statistical Package for Social Sciences (SPSS; Chicago, IL, USA) program, version 20.0. Results: Majority of the patients belonged to the age group 41- 60 years. Males comprised 161 (80.5%) patients of the study population. Hypertension was the most prevalent risk factor, observed in 101 (50.5%) patients. Left ventricular ejection fraction <40% was observed in 85 (42.5%) patients. Majority had low SYNTAX score {92 (46%)}. There was a significant difference in patients with Lp(a) <25 mg/dL compared to patients with Lp(a) >25 mg/dL with low (45.7% vs. 54.3%, p-value=0.0001), intermediate (9.9% vs. 90.1%, p-value=0.0001) and high SYNTAX scores (10.8% vs. 89.2%, p-value=0.0001), respectively. Conclusion: The Lp(a) was significantly associated with severity of CAD and it also displays prognostic significance.

scholarly journals Ten-year all-cause death after percutaneous or surgical revascularization for men and women with multivessel or left main coronary artery disease: insights from the SYNTAX extended survival study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Hara ◽  
K Takahashi ◽  
D Klaveren ◽  
M Ono ◽  
H Kawashima ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Mortality Rates ◽  
Public Institution ◽  
Funding Source ◽  
Left Main ◽  
Main Coronary Artery Disease ◽  
Artery Disease ◽  
Extended Survival

Abstract Background In patients with complex coronary artery disease (CAD), women favored coronary artery bypass grafting surgery (CABG) compared to percutaneous coronary intervention (PCI) at 5 years in the SYNTAX trial, whereas mortality rates after PCI and CABG were not different in men. On the other hand, poor outcomes of women undergoing PCI were not observed in the PRECOMBAT and BEST trials. The long-term optimal revascularization strategy according to gender has not been fully evaluated. Purpose In the SYNTAX Extended Survival (SYNTAXES) study, no significant difference existed in all-cause death between PCI and CABG at 10 years. This study aimed to assess treatment effect of PCI and CABG for 10-year all-cause death according to gender. Methods The SYNTAXES study evaluated vital status up to 10 years in 1,800 patients with de novo three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to treatment with CABG or PCI in the SYNTAX trial, and the pre-specified primary endpoint was all-cause death at 10 years. In this prespecified analysis, all-cause death at 10 years according to gender in patients undergoing PCI or CABG was evaluated. Results Of 1800 patients, 402 (22.3%) were women and 1398 (77.7%) were men. In women, the rate of mortality was significantly higher in the PCI arm at 5 years than in the CABG arm (19.3% vs. 10.3%; Log-rank p=0.010, Figure A), but the rates of mortality were not different at 10 years between the PCI and CABG arms (33.0% vs. 32.5%; Log-rank p=0.600, Figure A). In men, the mortality rate tended to be higher in the PCI arm at 10 years than in the CABG arm (27.0% vs. 22.5%; Log-rank p=0.082, Figure B), although the mortality rates were not different at 5 years between the PCI and CABG arms (12.4% vs. 12.3%; Log-rank p=0.957, Figure B). Conclusion The efficacy of CABG observed at 5 years disappeared at 10 years in women, whereas the efficacy of CABG became apparent after 5 years in men. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Erasmus University Medical Centre, Rotterdam, Netherlands, reference: MEC-2016-716

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