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

Arie Pieter Kappetein, Ted E. Feldman, Michael J. MacK, Marie Claude Morice, David R. Holmes, Elisabeth Ståhle, Keith D. Dawkins, Friedrich W. Mohr, Patrick W. Serruys, Antonio Colombo

Research output: Contribution to journalArticle

415 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2125-2134
Number of pages10
JournalEuropean heart journal
Volume32
Issue number17
DOIs
StatePublished - Sep 1 2011

Keywords

  • CABG
  • Left main
  • Multivessel disease
  • PCI
  • SYNTAX
  • Stent thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Kappetein, A. P., Feldman, T. E., MacK, M. J., Morice, M. C., Holmes, D. R., Ståhle, E., Dawkins, K. D., Mohr, F. W., Serruys, P. W., & 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. https://doi.org/10.1093/eurheartj/ehr213