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.

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%; Delta2.1% [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%; Delta-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%; Delta5.3% [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.

• Authors: Marie-Claude Morice, Patrick W Serruys, A Pieter Kappetein, Ted E Feldman, Elisabeth Ståhle, Antonio Colombo, Michael J Mack, David R Holmes, Lucia Torracca, Gerrit-Anne van Es, Katrin Leadley, Keith D Dawkins, Friedrich Mohr
• Journal: Circulation (Circulation) Vol. 121 Issue 24 Pg. 2645-53 (Jun 22 2010) ISSN: 1524-4539 [Electronic] United States
• PMID: 20530001 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Paclitaxel

Topics

• Aged
• Angioplasty, Balloon, Coronary
• Coronary Artery Bypass
• Coronary Artery Disease (complications, surgery, therapy)
• Drug-Eluting Stents
• Endpoint Determination
• Female
• Follow-Up Studies
• Humans
• Incidence
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (epidemiology)
• Myocardial Revascularization
• Paclitaxel
• Stroke (epidemiology)
• Treatment Outcome