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Due to the rapid progress in percutaneous coronary intervention (PCI) technology ranging from balloon angioplasty to bare-metal stents (BMS) and most recently drug-eluting stents (DES), multiple randomized clinical trials have been conducted over the last 20 years. Many of these trials have compared the outcomes of PCI to coronary artery bypass grafting (CABG), long considered the gold standard for treatment of stable multi-vessel disease, with other treatment options.
The recently conducted SYNTAX trial is one of the largest randomized, controlled trials to compare these two techniques and their outcomes. Based on the one-year results, both North American and European guidelines recommended PCI as a valuable treatment option for patients with left main (LM) disease and an alternative to CABG in patients with less complex three vessel disease (3VD) (SYNTAX score < 23).
At the conclusion of the trial, the five-year results of patients with 3VD who were treated with either CABG or PCI using first generation pacitaxel-eluding DES suggested that CABG should remain the standard of care as it resulted in significantly lower rates of death, as well as lower incidences of MI and repeat revascularization. Stroke rates for patients treated with these two techniques was the same.
For patients with low SYNTAX scores, PCI is an acceptable revascularization strategy, although it does have significantly higher rates of repeat revascularization.
SOURCE: Eur Heart J. 2014,35:2821-2830
