title: Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial.
abstract: OBJECTIVE
  Long-term randomized comparisons of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) in left main coronary (LM) disease and/or three-vessel disease (3VD) patients have been limited. This analysis compares 3-year outcomes in LM and/or 3VD patients treated with CABG or PCI with TAXUS Express stents.
  
  
  RESULTS
  SYNTAX is an 85-centre randomized clinical trial (n= 1800). Prospectively screened, consecutive LM and/or 3VD patients were randomized if amenable to equivalent revascularization using either technique; if not, they were entered into a registry. Patients in the randomized cohort will continue to be followed for 5 years. At 3 years, major adverse cardiac and cerebrovascular events [MACCE: death, stroke, myocardial infarction (MI), and repeat revascularization; CABG 20.2% vs. PCI 28.0%, P< 0.001], repeat revascularization (10.7 vs. 19.7%, P< 0.001), and MI (3.6 vs. 7.1%, P= 0.002) were elevated in the PCI arm. Rates of the composite safety endpoint (death/stroke/MI 12.0 vs. 14.1%, P= 0.21) and stroke alone (3.4 vs. 2.0%, P= 0.07) were not significantly different between treatment groups. Major adverse cardiac and cerebrovascular event rates were not significantly different between arms in the LM subgroup (22.3 vs. 26.8%, P= 0.20) but were higher with PCI in the 3VD subgroup (18.8 vs. 28.8%, P< 0.001).
  
  
  CONCLUSIONS
  At 3 years, MACCE was significantly higher in PCI- compared with CABG-treated patients. In patients with less complex disease (low SYNTAX scores for 3VD or low/intermediate terciles for LM patients), PCI is an acceptable revascularization, although longer follow-up is needed to evaluate these two revascularization strategies.
authors.affiliation: Department of Thoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands. a.kappetein@erasmusmc.nl
authors.forename: Arie Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.forename: Ted E
authors.initials: TE
authors.lastname: Feldman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ståhle
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000628:therapy*; D054855:Drug-Eluting Stents; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization / Q000379:methods; D012086:Reoperation; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome