title: Angiographic outcomes following stenting or coronary artery bypass surgery of the left main coronary artery: fifteen-month outcomes from the synergy between PCI with TAXUS express and cardiac surgery left main angiographic substudy (SYNTAX-LE MANS).
abstract: OBJECTIVE
  The SYNTAX-LE MANS substudy prospectively evaluated 15-month angiographic and clinical outcomes in patients with treated left main (LM) disease.
  
  
  RESULTS
  In the SYNTAX trial, 1,800 patients with three-vessel and/or LM disease were randomised to either CABG or PCI; of these, 271 LM patients were prospectively assigned to receive a 15-month angiogram. The primary endpoint for the CABG arm was the ratio of ≥50% to <100% obstructed/occluded grafts bypassing LM lesions to the number placed. The primary endpoint for the PCI arm was the proportion of patients with ≤50% diameter stenosis ('patent' stents) of treated LM lesions. Per protocol, no formal comparison between CABG and PCI arms was intended based on the differing primary endpoints. Available 15-month angiograms were analysed for 114 CABG and 149 PCI patients. At 15 months, 9.9% (26/263) of CABG grafts were 100% occluded and an additional 5.7% (15/263) were ≥50% to <100% occluded. Overall, 27.2% (31/114) of patients had ≥1 obstructed/occluded graft. The 15-month CABG MACCE rate was 8.8% (10/114) and MACCE at 15 months was not significantly associated with graft obstruction/occlusion (p=0.85). In the PCI arm, 92.4% (134/145) of patients had ≤50% diameter LM stenosis at 15 months (89.7% [87/97] distal LM lesions and 97.9% [47/48] non-distal LM lesions). The 15-month PCI MACCE rate was 12.8% (20/156) and this was significantly associated with lack of stent patency at 15 months (p<0.001), mainly due to repeat revascularisation.
  
  
  CONCLUSIONS
  At 15 months, 15.6% (41/263) of grafts were at least 50% obstructed but this was not significantly associated with MACCE; 92.4% (134/145) of patients had stents that remained patent at 15 months, and stent restenosis was significantly associated with MACCE, predominantly due to revascularisation.
authors.affiliation: Institut Hospitalier Jacques Cartier, Massy, France. mc.morice@icps.com.fr
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Ted E E
authors.initials: TE
authors.lastname: Feldman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ståhle
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Marie-Angèle
authors.initials: MA
authors.lastname: Morel
authors.forename: Marcel
authors.initials: M
authors.lastname: van den Brand
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Friedrich
authors.initials: F
authors.lastname: Mohr
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.forename: Gérard
authors.initials: G
authors.lastname: Fournial
authors.forename: Stefan
authors.initials: S
authors.lastname: James
authors.forename: Katrin
authors.initials: K
authors.lastname: Leadley
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D054855:Drug-Eluting Stents; D005060:Europe; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014654:Vascular Patency
chemical_list: D002317:Cardiovascular Agents; D017239:Paclitaxel