Lessons from the SYNTAX trial.

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Coronary artery bypass grafting (CABG) is the standard for multivessel and left main coronary artery disease.
• Percutaneous coronary intervention (PCI) has emerged as a competing revascularization strategy.
• PCI faces challenges including repeat revascularization, in-stent stenosis, and thrombosis.

Purpose of the Study:

• To compare the efficacy and safety of PCI versus CABG in patients with left main and/or three-vessel coronary artery disease.
• To evaluate whether PCI is non-inferior to CABG in this patient population.

Main Methods:

• The SYNTAX trial randomized patients with left main and/or three-vessel disease to receive either PCI with TAXus stents or CABG.
• Follow-up at 1 and 2 years assessed major adverse cardiovascular and cerebrovascular events (MACCE).

Main Results:

• PCI patients experienced significantly higher MACCE, primarily due to increased repeat revascularization.
• CABG patients had a significantly higher incidence of stroke.
• The composite endpoint of death, stroke, or myocardial infarction (MI) was comparable between PCI and CABG groups.
• The non-inferiority criterion for PCI was not met.

Conclusions:

• A multidisciplinary team approach is crucial for complex coronary artery disease treatment decisions.
• PCI and CABG should be viewed as complementary, not competitive, strategies.
• The SYNTAX Score aids in treatment selection: low/intermediate scores allow for PCI or CABG, while high scores favor CABG.
• Optimizing medical therapy is essential for patients undergoing CABG.