Five-year outcomes of staged percutaneous coronary intervention in the SYNTAX study.
OBJECTIVE
The SYNTAX study compared PCI with TAXUS Express stents to CABG for the treatment of de novo 3-vessel and/or left main coronary disease. This study aimed to determine patient characteristics and five-year outcomes after a staged PCI strategy compared to single-session PCI.


RESULTS
In the SYNTAX trial, staged procedures were discouraged but were allowed within 72 hours or, if renal insufficiency or contrast-induced nephropathy occurred, within 14 days (mean 9.8±18.1 days post initial procedure). A total of 125 (14%) patients underwent staged PCI. These patients had greater disease severity and/or required a more complex procedure. MACCE was significantly increased in staged patients (48.1% vs. 35.5%, p=0.004), as was the composite of death/stroke/MI (32.2% vs. 19%, p=0.0007). Individually, cardiac death and stroke occurred more frequently in the staged PCI group (p=0.03). Repeat revascularisation was significantly higher in staged patients (32.8% vs 24.8%, p=0.035), as was stent thrombosis (10.9% vs. 4.7%, p=0.005).


CONCLUSIONS
There is a higher incidence of MACCE in patients undergoing staged compared to single-session PCI for 3-vessel and/or left main disease over the first five years of follow-up. However, these patients had more comorbidities and more diffuse disease.
Golden Jubilee National Hospital, Glasgow, United Kingdom.
Stuart
S
Watkins
Keith G
KG
Oldroyd
Istvan
I
Preda
David R
DR
Holmes
Antonio
A
Colombo
Marie-Claude
MC
Morice
Katrin
K
Leadley
Keith D
KD
Dawkins
Friedrich W
FW
Mohr
Patrick W
PW
Serruys
Ted E
TE
Feldman
D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D016022:Case-Control Studies; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012086:Reoperation; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome