Do percutaneus coronary interventions with drug eluting stents replace cardiosurgery in multivessel disease and left main stenosis? Preliminary results of SYNTAX Trial Review article

Abstract

Multivessel disease (MVD) and left main (LM) stenosis are usually treated with cardiosurgery. Former papers reported superiority of coronary artery bypass graft surgery (CABG) over percutaneous coronary interventions (PCI) mainly in terms of restenosis. SYNTAX trial compares PCI with drug eluting stents (paclitaxel) with CABG in complexed anatomy (3VD or LM alone or with any other coronary stenosis). Primary clinical endpoint consists of death, MI, stroke and repeated revascularisation. The 12-month subset results for reported higher rates of overall MACCE for the PCI group (12,1% for CABG versus 17.8% for PCI, p=0,0015), but overall safety outcomes (death, stroke, MI) were similar for the two groups (7,7% for CABG versus 7,6% for PCI, p=0,98). As expected, the rate of revascularization was significantly higher in the PCI group (13,7% for PCI versus 5,9% for CABG, p <0,0001), while the rate of stroke was significantly higher in the CABG group (2,2% for CABG versus 0,6% for PCI, p=0,009).