Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial
Aims Long-term randomized comparisons of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) in left main coronary (LM) disease and/or three-vessel disease (3VD) patients have been limited. This analysis compares 3-year outcomes in LM and/or 3VD patients treated with CABG or PCI with TAXUS Express stents. Methods and resultsSYNTAX is an 85-centre randomized clinical trial (n 1800). Prospectively screened, consecutive LM and/or 3VD patients were randomized if amenable to equivalent revascularization using either technique; if not, they were entered into a registry. Patients in the randomized cohort will continue to be followed for 5 years. At 3 years, major adverse cardiac and cerebrovascular events [MACCE: death, stroke, myocardial infarction (MI), and repeat revascularization; CABG 20.2 vs. PCI 28.0, P< 0.001], repeat revascularization (10.7 vs. 19.7, P< 0.001), and MI (3.6 vs. 7.1, P 0.002) were elevated in the PCI arm. Rates of the composite safety endpoint (death/stroke/MI 12.0 vs. 14.1, P 0.21) and stroke alone (3.4 vs. 2.0, P 0.07) were not significantly different between treatment groups. Major adverse cardiac and cerebrovascular event rates were not significantly different between arms in the LM subgroup (22.3 vs. 26.8, P 0.20) but were higher with PCI in the 3VD subgroup (18.8 vs. 28.8, P< 0.001). Conclusion sAt 3 years, MACCE was significantly higher in PCI-compared with CABG-treated patients. In patients with less complex disease (low SYNTAX scores for 3VD or low/intermediate terciles for LM patients), PCI is an acceptable revascularization, although longer follow-up is needed to evaluate these two revascularization strategies.
|Keywords||CABG, Left main, Multivessel disease, PCI, SYNTAX, Stent thrombosis|
|Persistent URL||dx.doi.org/10.1093/eurheartj/ehr213, hdl.handle.net/1765/33637|
Kappetein, A.P., Feldman, T.E., Mack, M.J., Morice, M-C., Holmes, D.R., Stahle, E., … Colombo, A.. (2011). Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. European Heart Journal, 32(17), 2125–2134. doi:10.1093/eurheartj/ehr213