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SYNTAX and Bypass Surgery
Lessons learned from the SYNTAX trial after two years, the first surgical analysis paper of the SYNTAX trial has proven what I have blogged about on numerous previous occasions. The excellent results of 1% mortality, irrespective of the assigned SYNTAX Risk Score, compares VERY favorably with PCI. At two years better than expected outcomes have continued. As the EACTS 2010 presentation has already shown, this effect will persist in the years to come.
The original SYNTAX (in 2009) conclusions, “… the results of our trial show that CABG, as compared with PCI, is associated with a lower rate of major adverse cardiac or cerebrovascular events at 1 year among patients with three-vessel or left main coronary artery disease (or both) and should therefore remain the standard of care for such patients…” were reinforced at three years follow-up:
1) After one year:
2) After 3 years:
As reviewed before, will this type of evidence change the way these patients with 3 vessel and/or LMain disease are treated?
I doubt it, financial motivations and industry pressure will undoubtedly prevent this. In a complete denial of the 2009 conclusions mentioned above, SYNTAX' corporate sponsor, Boston Scientific, announced at the annual European Society of Cardiology (ESC) Congress in Barcelon that the overall results demonstrated no statistically significant difference between PCI and CABG in the composite safety endpoint (all-cause death, stroke and myocardial infarction).
"These results reinforce the one-year SYNTAX data and show impressive outcomes for PCI in patients with complex coronary anatomy, the majority of whom are normally treated with CABG surgery," said Keith D. Dawkins, M.D., Associate Chief Medical Officer of Boston Scientific.
Apart from wondering from what planet Dr. Dawkins hails, what would make you think future publications are going to be promoted differently?
- Complex coronary anatomy in coronary artery bypass graft surgery: Impact of complex coronary anatomy in modern bypass surgery? Lessons learned from the SYNTAX trial after two years, Mohr et al. J Thorac Cardiovasc Surg.2011; 141: 130-140.
- Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. Serruys PW, et al. N Engl J Med. 2009 Mar 5;360(10):961-72
- The 3-year Outcomes of the SYNTAX Trial, A. Pieter Kappetein, 24th EACTS Annual Meeting.
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