SYNTAX Compares Quality-of-Life Results for PCI With DES and CABG

March 17, 2011—In the New England Journal of Medicine, David J. Cohen, MD, et al have published findings from the SYNTAX (Taxus Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries) trial that investigated the quality-of-life effects of percutaneous coronary intervention (PCI) with the use of drug-eluting stents (2011;364:1016–1026). The SYNTAX study is sponsored by Boston Scientific Corporation (Natick, MA).

According to the investigators, previous studies have shown that among patients undergoing multivessel revascularization, coronary artery bypass grafting (CABG) results in greater relief from angina and improved quality of life compared with PCI either by balloon angioplasty or with the use of bare-metal stents. However, the impact of PCI with the use of drug-eluting stents on these outcomes is unknown.

As detailed in the New England Journal of Medicine, the investigators in this large, randomized trial assigned 1,800 patients with three-vessel or left main coronary artery disease to undergo either CABG (897 patients) or PCI with paclitaxel-eluting stents (903 patients). They assessed health-related quality of life at baseline and at 1, 6, and 12 months with the use of the Seattle Angina Questionnaire (SAQ) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The primary endpoint was the score on the angina-frequency subscale of the SAQ (on which scores range from 0 to 100, with higher scores indicating better health status).

The investigators reported that the scores on each of the SAQ and SF-36 subscales were significantly higher at 6 and 12 months than at baseline in both groups. The score on the angina-frequency subscale of the SAQ increased to a greater extent with CABG than with PCI at both 6 and 12 months (P = .04 and P = .03, respectively), but the between-group differences were small (mean treatment effect of 1.7 points at both time points). The proportion of patients who were free from angina was similar in the two groups at 1 and 6 months and was higher in the CABG group than in the PCI group at 12 months (76.3% vs 71.6%; P = .05). Scores on all the other SAQ and SF-36 subscales were either higher in the PCI group (mainly at 1 month) or were similar in the two groups throughout the follow-up period.

The SYNTAX investigators concluded that among patients with three-vessel or left main coronary artery disease, there was greater relief from angina after CABG than after PCI at 6 and 12 months, although the extent of the benefit was small.