Results of the Syntax trial suggests that PCI and CABG have comparable results for most patients with left main disease. The results suggest that the all-cause mortality was lower with PCI vs CABG in patients with Syntax scores <=32, but patients with Syntax scores >32 did better with CABG vs PCI.
In the manufacturer-sponsored SYNTAX trial of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with complex coronary artery disease, 5-year outcomes were similar in both groups (NEJM JW Cardiol Mar 6 2013). Now, investigators report 5-year results in the subgroup of 705 patients with left main (LM) disease. Follow-up was available for over 92% of patients in both arms.
The rate of the combined safety endpoint (death, stroke, or myocardial infarction [MI]) was about 20% in both groups. Cardiac mortality was 8.6% with PCI and 7.2% with CABG — a nonsignificant difference. The between-group difference in major adverse cardiovascular and cerebrovascular events (MACCEs) — the composite of all-cause death, MI, stroke, and repeat revascularization — was not significant in either the entire cohort or the small group (67 patients) with diabetes. Compared with CABG, PCI was associated with a slight but significant reduction in stroke (1.5% vs. 4.3%) and a significant increase in repeat revascularization (26.7% vs. 15.5%). In an analysis stratified by SYNTAX score, all-cause mortality was lower with PCI than with CABG in patients with scores ≤32 (7.9% vs. 15.1%; P=0.02); however, the MACCE rate was significantly higher with PCI in those with scores ≥33 (46.5% vs. 29.7%).
Morice M-C et al. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery trial. Circulation 2014 Jun 10; 129:2388. Link.