Single or multiple arterial bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel or left main coronary artery disease

Piroze M. Davierwala, Chao Gao, Daniel J.F.M. Thuijs, Rutao Wang, Hironori Hara, Masafumi Ono, Thilo Noack, Scot Garg, Neil O'Leary, Milan Milojevic, Arie Pieter Kappetein, Marie Claude Morice, Michael J. Mack, Robert Jan Van Geuns, David R. Holmes, Mario Gaudino, David P. Taggart, Yoshinobu Onuma, Friedrich Wilhelm Mohr, Patrick W. Serruys

Research output: Contribution to journalArticlepeer-review


Aim: The aim of this study was to compare long-term all-cause mortality between patients receiving percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using multiple (MAG) or single arterial grafting (SAG). Methods and results: The current study is a post hoc analysis of the SYNTAX Extended Survival Study, which compared PCI with CABG in patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD) and evaluated survival with ≥10 years of follow-up. The primary endpoint was all-cause mortality at maximum follow-up (median 11.9 years) assessed in the as-treated population. Of the 1743 patients, 901 (51.7%) underwent PCI, 532 (30.5%) received SAG, and 310 (17.8%) had MAG. At maximum follow-up, all-cause death occurred in 305 (33.9%), 175 (32.9%), and 70 (22.6%) patients in the PCI, SAG, and MAG groups, respectively (P < 0.001). Multiple arterial grafting [adjusted hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.49-0.89], but not SAG (adjusted HR 0.83, 95% CI 0.67-1.03), was associated with significantly lower all-cause mortality compared with PCI. In patients with 3VD, both MAG (adjusted HR 0.55, 95% CI 0.37-0.81) and SAG (adjusted HR 0.68, 95% CI 0.50-0.91) were associated with significantly lower mortality than PCI, whereas in LMCAD patients, no significant differences between PCI and MAG (adjusted HR 0.90, 95% CI 0.56-1.46) or SAG (adjusted HR 1.11, 95% CI 0.81-1.53) were observed. In patients with revascularization of all three major myocardial territories, a positive correlation was observed between the number of myocardial territories receiving arterial grafts and survival (Ptrend = 0.003). Conclusion: Our findings suggest that MAG might be the more desirable configuration for CABG to achieve lower long-term all-cause mortality than PCI in patients with 3VD and/or LMCAD. Trial registration: Registered on SYNTAXES: NCT03417050 (; SYNTAX: NCT00114972 (

Original languageEnglish (US)
Pages (from-to)1334-1344
Number of pages11
JournalEuropean heart journal
Issue number13
StatePublished - Apr 1 2022


  • Coronary artery bypass grafting
  • Multiple arterial grafting
  • Percutaneous coronary intervention
  • Single arterial grafting

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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