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Updated: May 28, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
[Modern coronary surgery, the SYNTAX trial and updated guidelines]
1Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, 24105, Kiel, Deutschland.
Insights
Coronary artery bypass grafting (CABG) offers significant advantages over percutaneous coronary intervention (PCI) for multi-vessel coronary heart disease, improving survival and reducing repeat procedures. A collaborative "heart team" approach is recommended for optimal patient therapy planning.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Trials
Context:
- Coronary artery bypass grafting (CABG) is the standard treatment for multi-vessel coronary heart disease.
- Percutaneous coronary intervention (PCI) has been evaluated as an alternative, particularly for complex coronary pathology.
Purpose:
- To compare the long-term outcomes of CABG versus PCI in patients with multi-vessel coronary heart disease.
- To evaluate the impact of coronary lesion complexity on treatment outcomes.
Summary:
- The 3-year SYNTAX trial results demonstrate superior outcomes for CABG compared to PCI, including lower rates of repeat revascularization, myocardial infarction, and improved survival.
- PCI showed comparable results only in specific cases, such as left main stem lesions or less complex multi-vessel disease.
- Complex coronary pathology was associated with worse outcomes for PCI.
Impact:
- The SYNTAX trial findings support CABG as the preferred revascularization strategy for most patients with multi-vessel coronary heart disease.
- The study emphasizes the importance of a multidisciplinary
- heart team
- approach in treatment planning, as recommended by updated EACTS/ESC guidelines.
- These results may influence future clinical practice and treatment guidelines for coronary heart disease management.
Abstract:
Coronary artery bypass grafting (CABG), a modern and safe procedure, is considered the therapy of choice in the care of patients with multi-vessel disease. The 3-year results of the SYNTAX trial not only showed surgical advantages in terms of repeat revascularisation, but the results also demonstrated significant surgical benefit for myocardial infarction and survival rates. More differentiated analyses showed distinct disadvantages in percutaneous coronary intervention (PCI) associated with the greater complexity of coronary pathology. PCI tends to be a comparable therapeutic option only in certain cases of left main stem lesions or multi-vessel disease. The findings from the SYNTAX study herald a new era in the treatment of coronary heart disease in which, as recommended in the updated guidelines issued by the EACTS/ESC in 2010, the interventionalist and the surgeon, working closely together as a"heart team", provide a sound therapy plan for affected patients.
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