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

Abstract

T he optimal revascularization strategy (coronary artery bypass surgery [CABG] Major adverse cardiac and cerebrovascular events were similar between arms in patients with low/intermediate SYNTAX scores but significantly increased in PCI patients with high scores (≥33). Conclusions-At 5 years, no difference in overall major adverse cardiac and cerebrovascular events was found between treatment groups. PCI-treated patients had a lower stroke but a higher revascularization rate versus CABG. These results suggest that both treatments are valid options for LM patients. The extent of disease should accounted for when choosing between surgery and PCI, because patients with high SYNTAX scores seem to benefit more from surgery compared with those in the lower tertiles. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00114972.

Comparison of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Artery Disease – 5-Year Outcome From CREDO-Kyoto PCI/CABG Registry Cohort-2 –

“…Subgroup analysis of ULMCAD patients in the SYNTAX randomized trial recently reported comparable 5-year cardiovascular outcomes for PCI and CABG. 13 The randomized control trial is the gold standard for comparing treatments, but generally enrolls selective patients without high risk profiles. On the other hand, observational study reflects real-world clinical practice, where there are many patients considered high risk such as the elderly, diabetics, and those with surgical ineligibility.…”

A Tale of Two Techniques: Demystifying the Myth

“…The final 5-year follow-up in patients with ULMCA disease also was published. 11 In contrast to patients with 3VD, no significant differences in MACCE were observed between PCI and CABG in patients with ULMCA disease (36.9% PCI vs. 31% CABG, P=0.12). However, CABG was associated with an increased rate of stroke (5% vs. 14%, P=0.03), which was counterbalanced by a higher revascularization rate in the PCI group (26.7% vs. 15.5%, P<0.01).…”

“…Moreover, incomplete revascularization and anatomical complexity (residual SYNTAX score) have been directly correlated to late all-cause mortality following PCI. 11,35,36 This was demonstrated in the PCI arm of the ULMCA subgroup of SYNTAX, for which the incidence of 5-year all-cause mortality was shown to markedly increase in subjects with a SYNTAX score ≥ 33 (5-year mortality of 20.9%) compared with subjects with a SYNTAX score < 33 (5-year mortality of 7.9%). Conversely, in subjects undergoing CABG, anatomical complexity was shown to not affect longterm prognosis, as exemplified in the CABG arm of the ULMCA subgroup of SYNTAX, for which the incidence of 5-year all-cause mortality remained almost unchanged in subjects with a SYNTAX score ≥ 33 (5-year mortality of 14.1%) compared with subjects with a SYNTAX score < 33 (5-year mortality of 15.1%).…”

Coronary artery bypass grafting versus percutaneous coronary intervention in complex coronary artery disease: looking beyond clinical end-points

“…In the 3VD cohort, CABG was found to be superior to PCI in terms of all cause death, MI and repeat revascularizations at 5 years follow up (7). However, in the UPLM subgroup, similar rates of all cause death and MI were observed with PCI and CABG, with a higher rate of revascularization in PCI and stroke in CABG arms (8). Further, in both cohorts' degree of complexity significantly affected outcomes thus favoring CABG in higher SYNTAX score patients.…”