Patients with three vessel disease should undergo PCI!

Point-Counter point 2

Best way to revascularize patients with main stem and three-vessel lesions: Patients should undergo PCI![i]

The optimal revascularization strategy for multivessel disease is under controversial discussion for long time. Until now, technical innovations have been faster than performance of clinical trials, making results of randomized studies outdated at the time of appearance.

Recently, the SYNTAX trial[ii] has been published, which compared drug elutings stents (DES) implantation with Coronary artery bypass graft (CABG) patients with multivessel or left main disease in a clinically stable population.

Overall, CABG was superior with respect to the clinical endpoint of death, myocardial infarction, stroke, or revascularization: 


More detailed analysis demonstrates that patients with more complex coronary anatomy gain even more benefit from CABG:


Somewhat surprisingly, the authors conclude next: ..."Regardless the results of SYNTAX, one should not forget that SYNTAX represents only a minority of daily patients in a catheterization laboratory, excluding patients with one or two-vessel disease and those with an acute coronary syndrome. Especially in the latter, percutaneous coronary intervention has demonstrated to improve prognosis..."


[i] Best way to revascularize patients with main stem and three vessel lesions: patients should undergo PCI!Volker Schächinger, et al, Clin Res Cardiol, 2010 Jul 9

[ii] Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease, Serruys PW et al, N Engl J Med 360:961–972