227 * DIFFERENCES IN CLINICAL OUTCOMES AFTER CONTEMPORARY CORONARY ARTERY BYPASS GRAFTING IN THE UNITED STATES AND EUROPE: INSIGHTS FROM THE SYNTAX RANDOMIZED TRIAL AND REGISTRY

Abstract

Objectives: Baseline characteristics and practice patterns of patients undergoing coronary artery bypass grafting (CABG) differ between the United States (US) and Europe. However, it remains unclear how clinical outcomes in the US and Europe compare. Methods: In the SYNTAX trial, 1511 patients with de novo left main and/or three-vessel disease underwent CABG either in the randomized arm or registry and were followed for five years. The impact of geographic enrolment on clinical outcomes was explored through Kaplan-Meier estimates and multivariate analyses. Results: There were 259 patients (16.8%) enrolled in the US. Patients treated in the US versus Europe had significantly higher rates of major adverse cardiac or cerebrovascular events (MACCE) (24.2% vs 17.6%, P = 0.018), but rates of the composite safety endpoint of death, stroke, and myocardial infarction were comparable (21.9% vs 22.3%, P = 0.85). Repeat revascularization occurred more frequently in the US versus Europe (13.6% vs 7.5%, P = 0.002), and was entirely driven by repeat percutaneous coronary intervention (PCI) (13.1% vs 6.7%, P = 0.001) and not repeat CABG (0.4% vs 0.8%, P = 0.51). In multivariate analyses, enrolment in the US remained an independent predictor of MACCE (HR = 1.42, 95% CI 1.05-1.92, P = 0.022) and repeat revascularization (HR = 1.93, 95% CI 1.27-2.92, P = 0.002) but not the composite safety endpoint. Five-year results were not yet available but will be at the time of the meeting. Conclusions: MACCE rates during three-year follow-up in the SYNTAX trial were significantly higher in the US as opposed to Europe. However, this appears to be entirely driven by increased rates of repeat PCI.