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Coronary artery disease

Similar 5-year outcomes with CABG surgery or PCI for left main disease

Nature Reviews Cardiology volume 11, pages 312–313 (2014)Cite this article

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The 5-year outcome data from patients with left main coronary artery disease who were enrolled in the SYNTAX trial show no difference in mortality or the rate of major adverse cardiac and cerebrovascular events (MACCE) between those treated by percutaneous coronary intervention (PCI) and those who underwent CABG surgery. However, because the noninferiority end point of 12-month MACCE was not met in the overall population of this trial, this subanalysis published in Circulation must be considered observational and hypothesis-generating.

In the SYNTAX trial, 705 patients had left main disease and were randomly assigned to receive PCI with a paclitaxel-eluting stent or CABG surgery. After 5 years, mortality was 12.8% in the PCI group and 14.6% in the CABG surgery group (HR 0.88, 95% CI 0.58–1.32, P = 0.53). The rate of MACCE was 36.9% and 31.0% in each group, respectively (HR 1.23, 95% CI 0.95–1.59, P = 0.12). The rates of all-cause death, cardiac death, and myocardial infarction did not significantly differ between the groups. However, the rate of stroke was significantly increased in the CABG surgery group (4.3% versus 1.5% with PCI; HR 0.33, 95% CI 0.12–0.92, P = 0.03), whereas the rate of repeat revascularization was significantly increased in the PCI group (26.7% versus 15.5% with CABG surgery; HR 1.82, 95% CI 1.28–2.57, P <0.01).

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References

  1. 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 SYNTAX trial. Circulation 10.1161/CIRCULATIONAHA.113.006689

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  1. Gregory B. Lim
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Lim, G. Similar 5-year outcomes with CABG surgery or PCI for left main disease. Nat Rev Cardiol 11, 312–313 (2014). https://doi.org/10.1038/nrcardio.2014.57

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