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[3-year results of the SYNTAX trial--stent or surgery? A surgeon's perspective]

Lenard Conradi1, Hermann Reichenspurner

  • 1Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Martinistrasse 52, Hamburg, Germany.

Clinical Research in Cardiology Supplements
|April 25, 2012
PubMed

Insights

Coronary artery bypass grafting (CABG) is superior to percutaneous coronary intervention (PCI) for complex coronary artery disease. An interdisciplinary heart team should guide treatment decisions for these patients.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Context:

  • Coronary artery bypass grafting (CABG) is the established treatment for complex coronary artery disease.
  • Percutaneous coronary intervention (PCI) is increasingly used, even for advanced lesions.
  • Clinical practice patterns diverge from established guidelines for myocardial revascularization.

Purpose:

  • To compare the efficacy of CABG versus PCI in patients with three-vessel or left main coronary artery disease.
  • To evaluate outcomes including repeat revascularization, myocardial infarction, and cardiac mortality.
  • To emphasize the importance of interdisciplinary heart team decision-making for complex coronary lesions.

Summary:

  • Large trials, including the SYNTAX trial, demonstrate CABG's superiority over PCI in advanced coronary artery disease.
  • CABG showed better outcomes in terms of repeat revascularization, myocardial infarction, and cardiac mortality at 3-year follow-up.
  • PCI remains a viable option for less complex left main coronary artery disease.

Impact:

  • Confirms CABG as the preferred revascularization strategy for three-vessel and left main coronary artery disease.
  • Highlights the necessity of formal, interdisciplinary heart team discussions for optimal patient management.
  • Supports updated European Society of Cardiology guidelines on myocardial revascularization.

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