Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial

Marie Claude Morice, Patrick W. Serruys, A. Pieter Kappetein, Ted E. Feldman, Elisabeth Ståhle, Antonio Colombo, Michael J. MacK, David Holmes, Lucia Torracca, Gerrit Anne Van Es, Katrin Leadley, Keith D. Dawkins, Friedrich Mohr

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Abstract

BACKGROUND-: The prospective, multinational, randomized Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial was designed to assess the optimal revascularization strategy between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), for patients with left main (LM) and/or 3-vessel coronary disease. METHODS AND RESULTS-: This observational hypothesis-generating analysis reports the results of a prespecified powered subgroup of 705 randomized patients who had LM disease among the 1800 patients with de novo 3-vessel disease and/or LM disease randomized to PCI with paclitaxel-eluting stents or CABG in the SYNTAX trial. Major adverse cardiac and cerebrovascular event rates at 1 year in LM patients were similar for CABG and PCI (13.7% versus 15.8%; Δ2.1% [95% confidence interval-3.2% to 7.4%]; P=0.44). At 1 year, stroke was significantly higher in the CABG arm (2.7% versus 0.3%; Δ-2.4% [95% confidence interval-4.2% to-0.1%]; P=0.009]), whereas repeat revascularization was significantly higher in the PCI arm (6.5% versus 11.8%; Δ5.3% [95% confidence interval 1.0% to 9.6%]; P=0.02); there was no observed difference between groups for other end points. When patients were scored for anatomic complexity, those with higher baseline SYNTAX scores had significantly worse outcomes with PCI than did patients with low or intermediate SYNTAX scores; outcomes for patients with CABG did not correlate with baseline SYNTAX score, but baseline EuroSCORE significantly predicted outcomes for both treatments. CONCLUSIONS-: Patients with LM disease who had revascularization with PCI had safety and efficacy outcomes comparable to CABG at 1 year; longer follow-up is required to determine whether these 2 revascularization strategies offer comparable medium-term outcomes in this group of complex patients.

Original languageEnglish (US)
Pages (from-to)2645-2653
Number of pages9
JournalCirculation
Volume121
Issue number24
DOIs
StatePublished - Jun 22 2010

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Taxus
Percutaneous Coronary Intervention
Paclitaxel
Coronary Artery Bypass
Thoracic Surgery
Stents
Transplants
Therapeutics
Confidence Intervals
Arm
Coronary Disease
Stroke
Safety

Keywords

  • angioplasty
  • coronary artery bypass grafting
  • percutaneous coronary
  • stents
  • transluminal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial. / Morice, Marie Claude; Serruys, Patrick W.; Kappetein, A. Pieter; Feldman, Ted E.; Ståhle, Elisabeth; Colombo, Antonio; MacK, Michael J.; Holmes, David; Torracca, Lucia; Van Es, Gerrit Anne; Leadley, Katrin; Dawkins, Keith D.; Mohr, Friedrich.

In: Circulation, Vol. 121, No. 24, 22.06.2010, p. 2645-2653.

Research output: Contribution to journalArticle

Morice, Marie Claude ; Serruys, Patrick W. ; Kappetein, A. Pieter ; Feldman, Ted E. ; Ståhle, Elisabeth ; Colombo, Antonio ; MacK, Michael J. ; Holmes, David ; Torracca, Lucia ; Van Es, Gerrit Anne ; Leadley, Katrin ; Dawkins, Keith D. ; Mohr, Friedrich. / Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial. In: Circulation. 2010 ; Vol. 121, No. 24. pp. 2645-2653.
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abstract = "BACKGROUND-: The prospective, multinational, randomized Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial was designed to assess the optimal revascularization strategy between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), for patients with left main (LM) and/or 3-vessel coronary disease. METHODS AND RESULTS-: This observational hypothesis-generating analysis reports the results of a prespecified powered subgroup of 705 randomized patients who had LM disease among the 1800 patients with de novo 3-vessel disease and/or LM disease randomized to PCI with paclitaxel-eluting stents or CABG in the SYNTAX trial. Major adverse cardiac and cerebrovascular event rates at 1 year in LM patients were similar for CABG and PCI (13.7{\%} versus 15.8{\%}; Δ2.1{\%} [95{\%} confidence interval-3.2{\%} to 7.4{\%}]; P=0.44). At 1 year, stroke was significantly higher in the CABG arm (2.7{\%} versus 0.3{\%}; Δ-2.4{\%} [95{\%} confidence interval-4.2{\%} to-0.1{\%}]; P=0.009]), whereas repeat revascularization was significantly higher in the PCI arm (6.5{\%} versus 11.8{\%}; Δ5.3{\%} [95{\%} confidence interval 1.0{\%} to 9.6{\%}]; P=0.02); there was no observed difference between groups for other end points. When patients were scored for anatomic complexity, those with higher baseline SYNTAX scores had significantly worse outcomes with PCI than did patients with low or intermediate SYNTAX scores; outcomes for patients with CABG did not correlate with baseline SYNTAX score, but baseline EuroSCORE significantly predicted outcomes for both treatments. CONCLUSIONS-: Patients with LM disease who had revascularization with PCI had safety and efficacy outcomes comparable to CABG at 1 year; longer follow-up is required to determine whether these 2 revascularization strategies offer comparable medium-term outcomes in this group of complex patients.",
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AU - Morice, Marie Claude

AU - Serruys, Patrick W.

AU - Kappetein, A. Pieter

AU - Feldman, Ted E.

AU - Ståhle, Elisabeth

AU - Colombo, Antonio

AU - MacK, Michael J.

AU - Holmes, David

AU - Torracca, Lucia

AU - Van Es, Gerrit Anne

AU - Leadley, Katrin

AU - Dawkins, Keith D.

AU - Mohr, Friedrich

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N2 - BACKGROUND-: The prospective, multinational, randomized Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial was designed to assess the optimal revascularization strategy between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), for patients with left main (LM) and/or 3-vessel coronary disease. METHODS AND RESULTS-: This observational hypothesis-generating analysis reports the results of a prespecified powered subgroup of 705 randomized patients who had LM disease among the 1800 patients with de novo 3-vessel disease and/or LM disease randomized to PCI with paclitaxel-eluting stents or CABG in the SYNTAX trial. Major adverse cardiac and cerebrovascular event rates at 1 year in LM patients were similar for CABG and PCI (13.7% versus 15.8%; Δ2.1% [95% confidence interval-3.2% to 7.4%]; P=0.44). At 1 year, stroke was significantly higher in the CABG arm (2.7% versus 0.3%; Δ-2.4% [95% confidence interval-4.2% to-0.1%]; P=0.009]), whereas repeat revascularization was significantly higher in the PCI arm (6.5% versus 11.8%; Δ5.3% [95% confidence interval 1.0% to 9.6%]; P=0.02); there was no observed difference between groups for other end points. When patients were scored for anatomic complexity, those with higher baseline SYNTAX scores had significantly worse outcomes with PCI than did patients with low or intermediate SYNTAX scores; outcomes for patients with CABG did not correlate with baseline SYNTAX score, but baseline EuroSCORE significantly predicted outcomes for both treatments. CONCLUSIONS-: Patients with LM disease who had revascularization with PCI had safety and efficacy outcomes comparable to CABG at 1 year; longer follow-up is required to determine whether these 2 revascularization strategies offer comparable medium-term outcomes in this group of complex patients.

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