title: SYNTAX-justified trend toward restricting coronary artery bypass grafting to more serious cases.
abstract: OBJECTIVE
  Since drug-eluting stents (DESs) appeared in Japan, coronary artery bypass grafting (CABG) has been indicated for more severe lesions. To understand the implications of this trend, we compared SYNTAX scores in two groups of patients treated with CABG before and after DESs approval.
  
  
  METHODS
  Consecutive CABG patients during January 2001-July 2003 (pre-DES era patients, n = 160) and January 2008-July 2010 (DES era patients, n = 103) were included. The SYNTAX scores of both groups were compared and a cardiologist retrospectively re-evaluated coronary angiograms to determine whether CABG or percutaneous coronary intervention (PCI) would be recommended under current standards.
  
  
  RESULTS
  SYNTAX scores were significantly higher in DES era group compared with pre-DES era group (33.3 ± 10.6 vs. 28.1 ± 10.6, p < 0.01). Percutaneous coronary intervention would be the preferred treatment option in 66 (41 %) of pre-DES patients, whose SYNTAX scores were significantly lower than those of patients who were considered good candidates for CABG (21.9 ± 9.3 vs. 32.5 ± 9.1, p < 0.01).
  
  
  CONCLUSIONS
  Although CABG is now being performed in intermediate-to-highly complex cases, DES era outcomes, including operative mortality and early graft failure, have not worsened in comparison to the pre-DES era.
authors: Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan, a_mamoru@mbn.nifty.com.
authors: Mamoru
authors: M
authors: Arakawa
authors: Atsushi
authors: A
authors: Yamaguchi
authors: Kenichi
authors: K
authors: Sakakura
authors: Homare
authors: H
authors: Okamura
authors: Junya
authors: J
authors: Ako
authors: Shin-Ichi
authors: S
authors: Momomura
authors: Hideo
authors: H
authors: Adachi
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D054855:Drug-Eluting Stents; D006801:Humans; D007564:Japan; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome