title: [3-year results of the SYNTAX trial--stent or surgery? A surgeon's perspective].
abstract: Coronary artery bypass grafting (CABG) is the standard of care for patients with three-vessel or left main coronary artery disease. However, clinical practice has proven to differ substantially with even the most complex coronary lesions being targeted by percutaneous coronary intervention (PCI) today. An abundancy of both large registries and randomized clinical trials has demonstrated superiority of surgery over PCI in advanced coronary artery disease. Recently, these results have been confirmed by the landmark SYNTAX trial where CABG was found to be superior to PCI for three-vessel and/or left main coronary artery disease regarding repeat revascularization, rate of myocardial infarction, and cardiac mortality at the latest follow-up of 3 years. On the other hand, PCI proved to be a viable alternative for less complex forms of left main disease.In conclusion, patients with three-vessel and/or left main coronary artery disease should be discussed in an interdisciplinary heart team consisting of cardiologists and cardiac surgeons within a heart center. Final decision making should be a formal process as recommended in the recently updated guidelines on myocardial revascularization by the European Society of Cardiology.
authors.affiliation: Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Martinistrasse 52, Hamburg, Germany.
authors.forename: Lenard
authors.initials: L
authors.lastname: Conradi
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
mesh_terms: D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome