Laura Rees Willett, MD
In patients with severe coronary artery disease, is percutaneous coronary intervention (PCI) noninferior to coronary artery bypass grafting (CABG) for preventing major adverse cardiac or cerebrovascular events?
Randomized controlled trial (Synergy between PCI with Taxus and Cardiac Surgery [SYNTAX]). ClinicalTrials.gov NCT00114972.
12 months after randomization.
85 centers in 17 countries in Europe and the USA.
1800 patients (mean age 65 y, 78% men) who had previously untreated 3-vessel or left main coronary artery disease; ≥ 50% target vessel stenosis; and angina, atypical chest pain or, if asymptomatic, positive evidence of myocardial ischemia. Exclusion criteria included previous PCI or CABG, acute myocardial infarction (MI), and need for concomitant cardiac surgery.
PCI with paclitaxel-eluting stents (n = 903) or CABG (n = 897) with the intention of achieving complete revascularization of all vessels ≥ 1.5 mm in diameter with stenosis of ≥ 50%.
A composite of major cardiac and cerebrovascular events (death from any cause, stroke, MI, or repeated revascularization). Secondary outcomes included individual components of the composite endpoint.
97% (intention-to-treat analysis).
Risks for the composite endpoint and repeated revascularization were higher after PCI than after CABG, but risk for stroke was lower (Table). Groups did not differ for death from any cause or MI (Table).
In patients with severe coronary artery disease, percutaneous coronary intervention was not as effective as coronary artery bypass grafting for preventing major adverse cardiovascular events.
Percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) for severe coronary artery disease†
†Abbreviations defined in Glossary. RRI, RRR, NNH, NNT, and CI calculated from data in article.
‡ Death from any cause, stroke, myocardial infarction, or repeated revascularization.
Willett LR. Percutaneous coronary intervention was not as effective as CABG for severe coronary artery disease. Ann Intern Med. ;151:JC1–9. doi: 10.7326/0003-4819-151-2-200907210-02009
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Published: Ann Intern Med. 2009;151(2):JC1-9.
Cardiology, Coronary Heart Disease.
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