Stenting shows more major adverse events than bypass grafting in complex patients at three years

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At three years, the rate of major adverse cardiac and cerebrovascular events is significantly higher with percutaneous coronary intervention compared with coronary artery bypass grafting in patients with left main or three-vessel disease, according to follow-up data from the SYNTAX trial. The results were published in the European Heart Journal.

“In patients with less complex disease (low SYNTAX scores for three-vessel disease or low/intermediate terciles for left main coronary disease patients), percutaneous coronary intervention is an acceptable revascularisation, although longer follow-up is needed to evaluate these two revascularisation strategies,” the authors wrote.

 

“Long-term randomised comparisons of percutaneous coronary intervention to coronary artery bypass grafting in left main coronary disease and/or three-vessel disease patients have been limited. This analysis compares three-year outcomes in left main and/or three-vessel disease patients treated with coronary artery bypass graft or percutaneous coronary intervention with Taxus Express drug-eluting stents (Boston Scientific),” they added.

 

SYNTAX is an 85-centre randomised clinical trial, involving 1,800 patients. Prospectively screened, consecutive left main and/or three-vessel disease patients were randomised if amenable to equivalent revascularisation using either technique; if not, they were entered into a registry.

Patients in the randomised cohort will continue to be followed for five years.

 

At three years, the rate of major adverse cardiac and cerebrovascular event (death, stroke, myocardial infarction and repeat revascularisation) was 20.2% with bypass grafting and 28% with percutaneous intervention (p<0.001). The percutaneous coronary intervention group also had higher rates of repeat revascularisation (10.7 vs. 19.7% with surgery, p<0.001) and myocardial infarction (3.6 vs. 7.1% surgery, p=0.002).

 

Rates of the composite safety endpoint (death/stroke/myocardial infarction) were 12% with bypass grafting vs. 14.1% with percutaneous intervention (p= 0.21) and the stroke alone rate was 3.4% for surgery vs. 2% for percutanous intervention (p=0.07). Both results were not significantly different between treatment groups.

 

Major adverse cardiac and cerebrovascular event rates were not significantly different between arms in the left main subgroup (22.3% vs. 26.8%, p=0.20) but were higher with percutaneous coronary intervention in the three-vessel disease subgroup (18.8% vs. 28.8%, p<0.001).

 

The authors of the paper are Arie Pieter Kappetein, Ted E Feldman, Michael J Mack, Marie-Claude Morice, David R Holmes, Elisabeth Ståhle, Keith D Dawkins, Friedrich W Mohr, Patrick W Serruys and Antonio Colombo.

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