Analysis of SYNTAX Shows Equal Outcomes for PCI and CABG

June 22, 2010—In Circulation, Marie-Claude Morice, MD, et al have published outcomes for patients with de novo left main disease treated with either percutaneous coronary intervention (PCI) using paclitaxel-eluting stents or coronary artery bypass graft (CABG) treatment in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial (Taxus paclitaxel-eluting stent, Boston Scientific Corporation, Natick, MA) (2010;121:2645–2653). SYNTAX is a prospective, multinational, randomized trial that was designed to assess the optimal revascularization strategy between PCI and CABG for patients with left main (LM) and/or three-vessel coronary disease.

As detailed in Circulation, this observational, hypothesis-generating analysis reported the results of a prespecified powered subgroup of 705 randomized patients who had LM disease among the 1,800 patients with de novo three-vessel disease and/or LM disease randomized to PCI with paclitaxel-eluting stents or CABG in the SYNTAX trial.

The investigators reported that major adverse cardiac and cerebrovascular event rates at 1 year in LM patients were similar for CABG and PCI (13.7% vs 15.8%; 2.1% [95% confidence interval [CI], -3.2%–7.4%]; P = .44). At 1 year, stroke was significantly higher in the CABG arm (2.7% vs 0.3%; -2.4% [95% CI, -4.2% to -0.1%; P = .009]), whereas repeat revascularization was significantly higher in the PCI arm (6.5% vs 11.8%; 5.3% [95% CI, 1%–9.6%]; P = .02); there was no observed difference between groups for other endpoints. 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.

The investigators concluded that 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 two revascularization strategies offer comparable medium-term outcomes in this group of complex patients.