The Syntax Trial

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Although coronary-artery bypass grafting (CABG) has been the standard of care for patients with left-main or three-vessel coronary disease who require revascularization, percutaneous coronary intervention (PCI) with stenting is also an option in such cases. These two interventions were compared in the SYNTAX trial, which was sponsored by the manufacturer of the Taxus drug-eluting stent.

Eighteen hundred patients with previously untreated left-main or three-vessel disease were randomized to CABG or PCI; in each case, either intervention was deemed feasible by a cardiologist and a surgeon. At 1 year, incidence of the primary composite endpoint (death, stroke, myocardial infarction, or repeat revascularization) was significantly lower with CABG than with PCI (12.4% vs. 17.8%). The Table shows differences in outcomes for individual components of the composite endpoint:

syntax outcomes

(From: Journal Watch General Medicine March 5, 2009)

“Currently available data emphasize the fact that CABG remains an excellent and often superior long-term form of revascularization in some selected groups of patients with two-vessel diseases and most groups of patients with three-vessels CAD. Currently available data emphasize the fact that CABG remains an excellent and often superior long-term form of revascularization in some selected groups of patients with two-vessel diseases and most groups of patients with three-vessels CAD”

References:

1): Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease, Serruys P et al. N Engl J Med2009; 360:961-972.

2):  Coronary Revascularization in Context, Richard A. Lange, M.D., and L. David Hillis, M.D., N Engl J Med2009; 360:1024-1026.

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